Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 036-103749 | IL |
NPI | 1013960244 |
---|---|
Provider Name | Dr. Beverlee A Brisbin |
First Address | Palos Hills, IL 60465-1971 |
Second Address | Palos Hills, IL 60465-1971 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250013909 | RAILROAD MEDICARE PROVIDER NUMBER (01) | IL |
H60765 | (02) | IL |