Healthcare Provider Details

I. General information

NPI: 1083458954
Provider Name (Legal Business Name): STEPHEN THOMAS TRYBAN MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PORTAGE ST
KALAMAZOO MI
49007-4929
US

IV. Provider business mailing address

54929 LAWSON CREEK DR
SHELBY TOWNSHIP MI
48316-3176
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-4400
  • Fax:
Mailing address:
  • Phone: 248-914-2303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4351056059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: