Provider Demographics
NPI:1417921107
Name:TRYGSTAD, ERIC W (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:TRYGSTAD
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 1:2220 RIVERSIDE AVE
Mailing Address - Street 2:31700A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1321
Mailing Address - Country:US
Mailing Address - Phone:612-371-1600
Mailing Address - Fax:612-371-1673
Practice Address - Street 1:2220 RIVERSIDE AVE
Practice Address - Street 2:31700A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1321
Practice Address - Country:US
Practice Address - Phone:612-371-1600
Practice Address - Fax:612-371-1673
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28441207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN731882100Medicaid
MN160001421Medicare ID - Type Unspecified
E22927Medicare UPIN