Provider Demographics
NPI:1619984127
Name:EWING, DEBRA J (DO)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:EWING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 E MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1626
Mailing Address - Country:US
Mailing Address - Phone:608-756-7100
Mailing Address - Fax:608-756-4700
Practice Address - Street 1:3524 E MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-1626
Practice Address - Country:US
Practice Address - Phone:608-756-7100
Practice Address - Fax:608-756-4700
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46938-021207Q00000X
CA13430207Q00000X
IN036126087207Q00000X
IN02004337A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIEWINGDEBOtherMERCYCARE INSURANCE
WI1619984127OtherBCBSWI
WI1619984127Medicaid
IL0361260872Medicaid
WII11991Medicare UPIN
WIK400152239-000054176Medicare PIN
WIEWINGDEBOtherMERCYCARE INSURANCE