1225016835 NPI number — DR. BRIAN JAY JELLISON MD

Table of content: DR. STEVEN A SILVER MD (NPI 1952387334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225016835 NPI number — DR. BRIAN JAY JELLISON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JELLISON
Provider First Name:
BRIAN
Provider Middle Name:
JAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225016835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9200 W WISCONSIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-3522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-805-2060
Provider Business Mailing Address Fax Number:
414-259-9290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-805-2060
Provider Business Practice Location Address Fax Number:
414-259-9290
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  223452 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 01061964A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD2008-0142 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 46406 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000393004 . This is a "ANTHEM-352047427" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1225016835 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2101688 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00331579 . This is a "RR MEDICARE-351158723" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 073863 . This is a "SIHO-351158723" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000492351 . This is a "ANTHEM 203778927" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 468500 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J28632 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000393001 . This is a "ANTHEM-351158723" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 073867 . This is a "SIHO-352047427" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200828930 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92753337 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q0433404 . This is a "SHOCMO351158723-352047427" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com