Provider Demographics
NPI:1518088897
Name:BILDSTEIN, RODGER DRUEHL (MD)
Entity Type:Individual
Prefix:DR
First Name:RODGER
Middle Name:DRUEHL
Last Name:BILDSTEIN
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 1:3830 EDGECLIFF COURT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-1062
Mailing Address - Country:US
Mailing Address - Phone:719-632-3140
Mailing Address - Fax:719-632-3140
Practice Address - Street 1:3830 EDGECLIFF COURT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1062
Practice Address - Country:US
Practice Address - Phone:719-632-3140
Practice Address - Fax:719-632-3140
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01136100Medicaid
CO01136100Medicaid
CO01136100Medicaid