Healthcare Provider Details

I. General information

NPI: 1801847173
Provider Name (Legal Business Name): MICHAEL A TRYGSTAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W PIKE ST
JACKSON CENTER OH
45334-9727
US

IV. Provider business mailing address

915 WEST MICHIGAN ST
SIDNEY OH
45365-2401
US

V. Phone/Fax

Practice location:
  • Phone: 937-596-6123
  • Fax: 937-596-6057
Mailing address:
  • Phone: 937-596-6123
  • Fax: 937-596-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-008129
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: