Provider Demographics
NPI:1649373838
Name:BRICKMAN, KRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:
Last Name:BRICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:FL 3
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-6383
Mailing Address - Fax:419-383-3357
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-3888
Practice Address - Fax:419-383-2860
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050118146D00000X
OH35.050118207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0561342Medicaid
OH000000142209OtherANTHEM
BR0547886Medicare ID - Type Unspecified
OH0561342Medicaid