Provider Demographics
NPI:1033308481
Name:NYGREN, HENRY CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CARL
Last Name:NYGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PRUDDEN ST
Mailing Address - Street 2:APT 138
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5383
Mailing Address - Country:US
Mailing Address - Phone:404-625-5261
Mailing Address - Fax:
Practice Address - Street 1:707 PRUDDEN ST
Practice Address - Street 2:APT 138
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5383
Practice Address - Country:US
Practice Address - Phone:404-625-5261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090614207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine