Healthcare Provider Details

I. General information

NPI: 1801258629
Provider Name (Legal Business Name): NICHOLAS CHRISTOPHER BRISSEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N ALLEN ST
ROBINSON IL
62454-1114
US

IV. Provider business mailing address

1000 N ALLEN ST
ROBINSON IL
62454-1114
US

V. Phone/Fax

Practice location:
  • Phone: 618-544-3131
  • Fax: 618-546-2603
Mailing address:
  • Phone: 618-544-3131
  • Fax: 618-546-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016-005769
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005796
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-005796
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: