Provider Demographics
NPI:1265740880
Name:BRUESCHKE, ERICH (PA)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:
Last Name:BRUESCHKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24247 N 121ST PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5931
Mailing Address - Country:US
Mailing Address - Phone:405-834-2993
Mailing Address - Fax:
Practice Address - Street 1:903 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1906
Practice Address - Country:US
Practice Address - Phone:602-416-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant