Provider Demographics
NPI:1699940080
Name:BRUESCHKE, ERICH E (MD)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:E
Last Name:BRUESCHKE
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 1:2250 LANDMEIER RD STE B
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-2623
Mailing Address - Country:US
Mailing Address - Phone:312-576-1934
Mailing Address - Fax:
Practice Address - Street 1:2250 LANDMEIER RD STE B
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-2623
Practice Address - Country:US
Practice Address - Phone:312-576-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine