Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | LL39592 | SC |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 125078089 | IL |
NPI | 1215386628 |
---|---|
Provider Name | Brian Thomas Sleasman |
First Address | Charleston, SC 29425-8905 |
Second Address | Chicago, IL 60611-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 10/06/2021 |