Jellison, Brian Jay
Jellison, Brian Jay is an individual health care provider with primary practice located at 9200 W Wisconsin Ave , Milwaukee WI 53226-3522. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Jellison, Brian Jay can be contacted via phone (414) 805-2060.Contact Information
Primary practice address
9200 W Wisconsin Ave
Milwaukee WI 53226-3522
Phone: (414) 805-2060
Fax: (414) 259-9290
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 223452 | Massachusetts |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 01061964A | Indiana |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | MD2008-0142 | New Mexico |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 46406 | Wisconsin |
Profile Details
| NPI number | 1225016835 |
|---|---|
| LBN Legal business name | Jellison, Brian Jay |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 4th, 2006 |
| Last updated | Mar 31st, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225016835 | NPPES |
| Indiana | Other | 000000393004 | ANTHEM-352047427 |
| Indiana | MEDICAID | 1225016835 | ANTHEM-352047427 |
| Indiana | MEDICAID | 2101688 | ANTHEM-352047427 |
| Indiana | Other | P00331579 | ANTHEM-352047427 |
| Indiana | Other | 073863 | ANTHEM-352047427 |
| Indiana | Other | 000000492351 | ANTHEM-352047427 |
| Indiana | Other | 468500 | ANTHEM-352047427 |
| Indiana | Other | J28632 | ANTHEM-352047427 |
| Indiana | Other | 000000393001 | ANTHEM-352047427 |
| Indiana | Other | 073867 | ANTHEM-352047427 |
| Indiana | MEDICAID | 200828930 | ANTHEM-352047427 |
| Indiana | MEDICAID | 92753337 | ANTHEM-352047427 |
| Indiana | Other | Q0433404 | ANTHEM-352047427 |
Popular Providers
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