MEDICARE: DR. ERIC DONALD BIEWENGA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	A109989	CA
2	208800000X	Urology Physician	DR.0070922	CO

General Provider Information

NPI Number	:	1154581965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC DONALD BIEWENGA M.D.

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE STE 150
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9071
Country	:	US
Telephone Number	:	970-624-4034
Fax Number	:

Provider Business Practice Location Address
First Line	:	3843 RIO VISTA DR STE 2300
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-3380
Country	:	US
Telephone Number	:	719-365-3700
Fax Number	:	719-365-3701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2008
Last Update Date	:	05/10/2024

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