Basic Information
| Provider Information | |||||||||
| NPI: | 1013919455 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRIESKE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7093 HERON CIR | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920113975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608142045 | ||||||||
| FaxNumber: | 3105380929 | ||||||||
| Practice Location | |||||||||
| Address1: | 4002 VISTA WAY | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609405606 | ||||||||
| FaxNumber: | 7609404007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 43799 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080181680 | 01 | WI | RAILROAD MEDICARE | OTHER | 34140600 | 05 | WI | MEDICAID | 2104038 | 01 | WI | FIRST HEALTH | OTHER | 13046 | 01 | WI | DEAN HEALTH PLAN | OTHER | 78B99BR | 01 | WI | ATRIUM COMMERCIAL | OTHER | 39092953812 | 01 | WI | UNITY - ELROY CLINIC | OTHER | 1038473 | 01 | WI | PHYSICIANS PLUS | OTHER | 2004 | 01 | WI | MMSI | OTHER | 39092953815 | 01 | WI | UNITY - HILLSBORO CLINIC | OTHER | 9667272P01 | 01 | WI | CIGNA | OTHER | HP67021 | 01 | WI | HEALTH PARTNERS | OTHER |