Provider Demographics
NPI:1497633127
Name:BRISCOE, MICHAEL (CPRS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BRISCOE
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-0602
Mailing Address - Country:US
Mailing Address - Phone:614-506-6104
Mailing Address - Fax:
Practice Address - Street 1:551 1/2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3809
Practice Address - Country:US
Practice Address - Phone:614-404-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006765175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist