Provider Demographics
NPI:1265412233
Name:BRILZ, DOROTA (MD)
Entity type:Individual
Prefix:DR
First Name:DOROTA
Middle Name:
Last Name:BRILZ
Suffix:
Gender:F
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:16120 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2049
Practice Address - Country:US
Practice Address - Phone:402-354-0610
Practice Address - Fax:402-354-0611
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081007300Medicaid
NE47068731785Medicaid
IA5227074Medicaid
IA1265412233Medicaid