=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376991802
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD T BRIZENDINE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2016
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 W IRONWOOD DR STE 378
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-625-3555
-----------------------------------------------------
Fax | 208-769-8616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 W IRONWOOD DR STE 378
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-625-3555
-----------------------------------------------------
Fax | 208-769-8616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | M-16208
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | M-16208
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------