Provider Demographics
NPI:1316423056
Name:PROSOSKI, BRIA RAYOME (MD)
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:RAYOME
Last Name:PROSOSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIA
Other - Middle Name:HANNEMAN
Other - Last Name:RAYOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:262-723-3100
Mailing Address - Fax:
Practice Address - Street 1:201 E MORRISSY DR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4395
Practice Address - Country:US
Practice Address - Phone:262-723-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
WI72307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100101823Medicaid