Provider Demographics
NPI:1427211309
Name:CHASE, CARISSA ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ELAINE
Last Name:CHASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:ELAINE
Other - Last Name:VILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4735 WEST RIVER DR NE
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9602
Mailing Address - Country:US
Mailing Address - Phone:616-784-9400
Mailing Address - Fax:616-784-5167
Practice Address - Street 1:4735 WEST RIVER DR NE
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-9602
Practice Address - Country:US
Practice Address - Phone:616-784-9400
Practice Address - Fax:616-784-5167
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107740208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics