Provider Demographics
NPI:1801258629
Name:BRISSEY, NICHOLAS CHRISTOPHER (DPM)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHRISTOPHER
Last Name:BRISSEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1114
Mailing Address - Country:US
Mailing Address - Phone:618-544-3131
Mailing Address - Fax:618-546-2603
Practice Address - Street 1:1000 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1114
Practice Address - Country:US
Practice Address - Phone:618-544-3131
Practice Address - Fax:618-546-2603
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005769213E00000X
IL016005796213ES0103X
IL016-005796213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist