Provider Demographics
NPI:1124025531
Name:BRINGAS, ENRIQUE M (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:M
Last Name:BRINGAS
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 1:865 LINCOLN RD
Mailing Address - Street 2:SUITE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4190
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:615 VALLEY VIEW DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6150
Practice Address - Country:US
Practice Address - Phone:309-764-9404
Practice Address - Fax:309-764-9406
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-08-10
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
IL036099834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA91287OtherWELLMARK BC/BS
IL036099834Medicaid
067317OtherHEALTH ALLIANCE
ILH09474Medicaid
IL01E5OtherJOHN DEERE HEALTH PLANS
4796890021OtherDMERC
510146OtherIOWA HEALTH SOLUTIONS
ILL95027Medicare PIN
H09474Medicare UPIN
067317OtherHEALTH ALLIANCE
ILH09474Medicaid