Provider Demographics
NPI:1033115043
Name:BRITT, ANDREW MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:BRITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503A N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-2443
Mailing Address - Country:US
Mailing Address - Phone:618-842-2491
Mailing Address - Fax:618-842-2497
Practice Address - Street 1:503A N 1ST ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2443
Practice Address - Country:US
Practice Address - Phone:618-842-2491
Practice Address - Fax:618-842-2497
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.109965207P00000X, 207Q00000X
IL036109965207P00000X
KYC1936207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109965Medicaid
IL206679OtherMEDICARE PTAN
IL036109965Medicaid