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NPI Code Detail

MEDICARE: DR. STEPHAN PODRYGULA PH.D.

MEDICARE: DR. STEPHAN PODRYGULA PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist136ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1POD5241OTHERNDBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205821527
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHAN PODRYGULA PH.D.
Provider Business Mailing Address
First Line : 600 22ND AVE NW
Second Line : NORTHLAND PROFESSIONAL BUILDING
City : MINOT
State : ND
Zip : 58703-0986
Country : US
Telephone Number : 701-852-9113
Fax Number : 701-838-0779
Provider Business Practice Location Address
First Line : 600 22ND AVE NW
Second Line : NORTHLAND PROFESSIONAL BUILDING
City : MINOT
State : ND
Zip : 58703-0986
Country : US
Telephone Number : 701-852-9113
Fax Number : 701-838-0779
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 02/27/2009

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