Provider Demographics
NPI:1740676592
Name:PYRCH, KRISSA M (DO)
Entity type:Individual
Prefix:
First Name:KRISSA
Middle Name:M
Last Name:PYRCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISSA
Other - Middle Name:MARY
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W12802 COUNTY HWY A
Mailing Address - Street 2:
Mailing Address - City:BOWLER
Mailing Address - State:WI
Mailing Address - Zip Code:54416
Mailing Address - Country:US
Mailing Address - Phone:715-793-5031
Mailing Address - Fax:715-793-5028
Practice Address - Street 1:W12802 COUNTY HWY A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416
Practice Address - Country:US
Practice Address - Phone:715-793-5031
Practice Address - Fax:715-793-5028
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI70502-21207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100088245Medicaid