Provider Demographics
NPI:1013919455
Name:BRIESKE, TIMOTHY A (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:BRIESKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7093 HERON CIR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-3975
Mailing Address - Country:US
Mailing Address - Phone:760-814-2045
Mailing Address - Fax:310-538-0929
Practice Address - Street 1:4002 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056
Practice Address - Country:US
Practice Address - Phone:760-940-5606
Practice Address - Fax:760-940-4007
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI080181680OtherRAILROAD MEDICARE
WI34140600Medicaid
WI2104038OtherFIRST HEALTH
WI13046OtherDEAN HEALTH PLAN
WI78B99BROtherATRIUM COMMERCIAL
WI39092953812OtherUNITY - ELROY CLINIC
WI1038473OtherPHYSICIANS PLUS
WI2004OtherMMSI
WI39092953815OtherUNITY - HILLSBORO CLINIC
WI9667272P01OtherCIGNA
WIHP67021OtherHEALTH PARTNERS
WI0004Medicare ID - Type UnspecifiedFACILITY 31005
WI1038473OtherPHYSICIANS PLUS
WIHP67021OtherHEALTH PARTNERS