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NPI Code Detail

MEDICARE: DR. CARISSA TYO M.D.

MEDICARE: DR. CARISSA TYO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician036112405IL
2207P00000XEmergency Medicine Physician83453WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205843398
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARISSA TYO M.D.
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 3400 UNION AVE
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53081-8426
Country : US
Telephone Number : 920-802-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 05/06/2025

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Directions to “ DR. CARISSA TYO M.D.” Practice Location

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