MEDICARE: MR. BRETT MILAN LOSEKE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1053607838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRETT MILAN LOSEKE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 209
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68702-0209
Country	:	US
Telephone Number	:	402-371-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 N 13TH ST
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2669
Country	:	US
Telephone Number	:	402-371-0123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	01/10/2012

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