MEDICARE: DR. BARBARA R BRISK-ZIZIC DDS

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
1	1223G0001X	General Practice Dentistry	19017123	IL

General Provider Information

NPI Number	:	1124149174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA R BRISK-ZIZIC DDS

Provider Business Mailing Address
First Line	:	25 E WASHINGTON ST STE 1905
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1823
Country	:	US
Telephone Number	:	312-641-0002
Fax Number	:	312-641-2258

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST STE 1905
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1823
Country	:	US
Telephone Number	:	312-641-0002
Fax Number	:	312-641-2258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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