Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016005221 | IL |
Y | 222Z00000X | Podiatrist | 016005221 | IL |
N | 213E00000X | Podiatrist | 07000977A | IN |
N | 222Z00000X | Podiatrist | 07000977A | IN |
N | 213EP0504X | Public Medicine | 016005221 | IL |
N | 213EP0504X | Public Medicine | 07000977A | IN |
N | 213EP1101X | Primary Podiatric Medicine | 016005221 | IL |
N | 213EP1101X | Primary Podiatric Medicine | 07000977A | IN |
N | 213ES0103X | Foot & Ankle Surgery | 016005221 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 07000977A | IN |
N | 213ES0131X | Foot Surgery | 016005221 | IL |
N | 213ES0131X | Foot Surgery | 07000977A | IN |
NPI | 1477559466 |
---|---|
Provider Name | Brian Andrew Opensky |
First Address | Olympia Fields, IL 60461-1862 |
Second Address | Olympia Fields, IL 60461-1862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000341268 | ANTHEM (01) | IN |
00002479469 06 | UNITED HEALTHCARE (01) | IL |
200-418510 | (05) | IN |
7785640 | AETNA (01) | IL |
V01462 | (02) | IN |