Provider Demographics
NPI:1013960244
Name:BRISBIN, BEVERLEE A (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLEE
Middle Name:A
Last Name:BRISBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10330 S ROBERTS RD
Mailing Address - Street 2:MIDAMERICA ORTHOPAEDICS, S.C.
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1971
Mailing Address - Country:US
Mailing Address - Phone:708-237-7200
Mailing Address - Fax:708-237-7201
Practice Address - Street 1:10330 S ROBERTS RD
Practice Address - Street 2:MIDAMERICA ORTHOPAEDICS, S.C.
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1971
Practice Address - Country:US
Practice Address - Phone:708-237-7200
Practice Address - Fax:708-237-7201
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-103749207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL250013909OtherRAILROAD MEDICARE PROVIDER NUMBER
ILIL5519008Medicare PIN
IL1032380001Medicare NSC
IL250013909OtherRAILROAD MEDICARE PROVIDER NUMBER
ILIL5520008Medicare PIN