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NPI Code Detail

MEDICARE: ERICH BRUESCHKE P.A.

MEDICARE: ERICH BRUESCHKE P.A.
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1265740880
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICH BRUESCHKE P.A.
Provider Business Mailing Address
First Line : 24247 N 121ST PL
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85255-5931
Country : US
Telephone Number : 405-834-2993
Fax Number :
Provider Business Practice Location Address
First Line : 903 N 2ND ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-1906
Country : US
Telephone Number : 602-416-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2010
Last Update Date : 09/16/2010

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