Provider Demographics
NPI:1346781630
Name:TREECE, CHARISSE LIZ (MD)
Entity Type:Individual
Prefix:
First Name:CHARISSE LIZ
Middle Name:
Last Name:TREECE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARISSE LIZ
Other - Middle Name:
Other - Last Name:BASTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 HIGHLAND AVE RM A4204
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-3224
Mailing Address - Country:US
Mailing Address - Phone:608-263-8443
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE RM A4204
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-3224
Practice Address - Country:US
Practice Address - Phone:608-263-8443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81200207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology