Healthcare Provider Details

I. General information

NPI: 1013960244
Provider Name (Legal Business Name): BEVERLEE A BRISBIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 S ROBERTS RD MIDAMERICA ORTHOPAEDICS, S.C.
PALOS HILLS IL
60465-1971
US

IV. Provider business mailing address

10330 S ROBERTS RD MIDAMERICA ORTHOPAEDICS, S.C.
PALOS HILLS IL
60465-1971
US

V. Phone/Fax

Practice location:
  • Phone: 708-237-7200
  • Fax: 708-237-7201
Mailing address:
  • Phone: 708-237-7200
  • Fax: 708-237-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036-103749
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: