MEDICARE: MICHAEL A TRYGSTAD DO

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
1	207Q00000X	Family Medicine Physician	34-008129	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801847173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A TRYGSTAD DO

Provider Business Mailing Address
First Line	:	915 WEST MICHIGAN ST
Second Line	:
City	:	SIDNEY
State	:	OH
Zip	:	45365-2401
Country	:	US
Telephone Number	:	937-596-6123
Fax Number	:	937-596-6057

Provider Business Practice Location Address
First Line	:	602 W PIKE ST
Second Line	:
City	:	JACKSON CENTER
State	:	OH
Zip	:	45334-9727
Country	:	US
Telephone Number	:	937-596-6123
Fax Number	:	937-596-6057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	12/02/2020

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Directions to “ MICHAEL A TRYGSTAD DO” Practice Location

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