MEDICARE: KIRK MATTHEW BRISNEHAN D.O.

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	207Q00000X	Family Medicine Physician	010741	AZ
2	207Q00000X	Family Medicine Physician	OS12402	FL

General Provider Information

NPI Number	:	1649596628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK MATTHEW BRISNEHAN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 W CHANDLER BLVD STE 4
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6177
Country	:	US
Telephone Number	:	480-899-2900
Fax Number	:	833-973-4362

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	01/29/2026

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