Individual
DR. BRIAN JAY JELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-2060
(414) 259-9290
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-2060
(414) 259-9290
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01061964A
IN
2085R0202X
Diagnostic Radiology Physician
223452
MA
2085R0202X
Diagnostic Radiology Physician
Primary
46406
WI
2085R0202X
Diagnostic Radiology Physician
MD2008-0142
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000393001
ANTHEM-351158723
IN
01
—
000000393004
ANTHEM-352047427
IN
01
—
000000492351
ANTHEM 203778927
IN
01
—
073863
SIHO-351158723
IN
01
—
073867
SIHO-352047427
IN
05
—
1225016835
—
WI
05
—
200828930
—
IN
05
—
2101688
—
MA
01
—
468500
TUFTS HEALTH PLAN
MA
05
—
92753337
—
NM
01
—
J28632
BCBS OF MA
MA
01
—
P00331579
RR MEDICARE-351158723
IN
01
—
Q0433404
SHOCMO351158723-352047427
IN
Enumeration date
01/04/2006
Last updated
03/31/2023
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