Healthcare Provider Details

I. General information

NPI: 1780653303
Provider Name (Legal Business Name): DANIEL ALFRED BRZUSEK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 116TH AVE NE SUITE 202
BELLEVUE WA
98004-3056
US

IV. Provider business mailing address

1600 116TH AVE NE SUITE 202
BELLEVUE WA
98004-3056
US

V. Phone/Fax

Practice location:
  • Phone: 425-453-1000
  • Fax: 425-454-3590
Mailing address:
  • Phone: 425-453-1000
  • Fax: 425-454-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOP00000727
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: