Provider Demographics
NPI:1073597324
Name:PROSSICK, TRISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:
Last Name:PROSSICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 W 151ST STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5300
Mailing Address - Country:US
Mailing Address - Phone:913-764-1125
Mailing Address - Fax:913-764-1186
Practice Address - Street 1:153 W 151ST STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-764-1125
Practice Address - Fax:913-764-1186
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31231207N00000X
KS0431231207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00456767OtherRR MEDICARE
P00456767OtherRR MEDICARE