Provider Demographics
NPI:1154581965
Name:BIEWENGA, ERIC DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DONALD
Last Name:BIEWENGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4034
Mailing Address - Fax:
Practice Address - Street 1:3843 RIO VISTA DR STE 2300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3380
Practice Address - Country:US
Practice Address - Phone:719-365-3700
Practice Address - Fax:719-365-3701
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-15
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109989208800000X
CODR.0070922208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology