Provider Demographics
NPI:1780653303
Name:BRZUSEK, DANIEL ALFRED (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALFRED
Last Name:BRZUSEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 116TH AVE NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3056
Mailing Address - Country:US
Mailing Address - Phone:425-453-1000
Mailing Address - Fax:425-454-3590
Practice Address - Street 1:1600 116TH AVE NE
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3056
Practice Address - Country:US
Practice Address - Phone:425-453-1000
Practice Address - Fax:425-454-3590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000007272081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0033221OtherL&I NUMBER
WA0033221OtherL&I NUMBER