Provider Demographics
NPI:1376529941
Name:BICKFORD, EILEEN G (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:G
Last Name:BICKFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:G
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:580 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-3712
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO021842OtherKAISER COMMERCIAL NUMBER
CO73934577Medicaid
CO021842OtherKAISER COMMERCIAL NUMBER
COH96071Medicare UPIN
CO73934577Medicaid