Provider Demographics
NPI:1609897248
Name:BRISSO, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BRISSO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2222 S 16TH ST
Mailing Address - Street 2:STE 400A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3796
Mailing Address - Country:US
Mailing Address - Phone:402-483-8590
Mailing Address - Fax:402-483-8599
Practice Address - Street 1:1600 S 48TH ST
Practice Address - Street 2:NEONATOLGY
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1283
Practice Address - Country:US
Practice Address - Phone:402-481-7333
Practice Address - Fax:402-481-7579
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-12-01
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Provider Licenses
StateLicense IDTaxonomies
NE10802183500000X
NE215232080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200379810AMedicaid
NE470780857 02Medicaid
KS200379810AMedicaid
NE470780857 02Medicaid