Provider Demographics
NPI:1679041172
Name:JONATHAN E THYGESON, M.D., INC., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JONATHAN E THYGESON, M.D., INC., A MEDICAL CORPORATION
Other - Org Name:JONATHAN THYGESON MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:THYGESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-924-8754
Mailing Address - Street 1:755 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6708
Mailing Address - Country:US
Mailing Address - Phone:916-924-8754
Mailing Address - Fax:916-924-1739
Practice Address - Street 1:755 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6708
Practice Address - Country:US
Practice Address - Phone:916-924-8754
Practice Address - Fax:916-924-1739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONATHAN E THYGESON, M.D., INC., A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-02
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154494543OtherDON R VAN SCHENCK
VA1578504379OtherMARKETA LEISURE MD
AZ1811990625OtherPHILIP TRAQUAIR
1790744704OtherJONATHAN E THYGESON