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General NPI Number Information
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NPI Number | 1801258629
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Entity Type | Individual
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Provider Name | NICHOLAS CHRISTOPHER BRISSEY DPM
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1000 N ALLEN ST
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City | ROBINSON
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State | IL
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Zip | 62454-1114
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Country | US
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Telephone | 618-544-3131
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Fax | 618-546-2603
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Provider Business Mailing Address
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Address Line | 1000 N ALLEN ST
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City | ROBINSON
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State | IL
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Zip | 62454-1114
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Country | US
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Telephone | 618-544-3131
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Fax | 618-546-2603
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016-005769
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005796
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016-005796
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License Number State | IL
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