Provider Demographics
NPI:1245404961
Name:TRANDEM, KARYSSE (DO)
Entity Type:Individual
Prefix:DR
First Name:KARYSSE
Middle Name:
Last Name:TRANDEM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6005
Mailing Address - Country:US
Mailing Address - Phone:239-262-3399
Mailing Address - Fax:239-261-0080
Practice Address - Street 1:775 1ST AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6005
Practice Address - Country:US
Practice Address - Phone:239-262-3399
Practice Address - Fax:239-261-0080
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55809207V00000X
FLOS12879207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013686600Medicaid
FL150VWOtherBC/BS FL
FL013686600Medicaid