1972571099 NPI number — TERRY E PIETRYGA M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972571099 NPI number — TERRY E PIETRYGA M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PIETRYGA

Provider First Name:

TERRY

Provider Middle Name:

E

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1972571099

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/09/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3570 SUNNINGDALE DR N

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAGINAW

Provider Business Mailing Address State Name:

MI

Provider Business Mailing Address Postal Code:

48604-9772

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

810-252-2194

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2213 CHERRY ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TOLEDO

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

43608-2603

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

419-251-3232

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

03/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  35.085668 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2085R0202X , with the licence number: 435570 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 4301072096 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 01060109A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 4692907 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: P00191476 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000354582 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 2535411 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 4692916 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 4692961 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 4692952 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".