Provider Demographics
NPI:1831134352
Name:RIGSTAD, EUGENE CLIFFORD (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:CLIFFORD
Last Name:RIGSTAD
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 1:3916 N INTERTECH CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-6957
Mailing Address - Country:US
Mailing Address - Phone:920-996-1000
Mailing Address - Fax:920-996-1054
Practice Address - Street 1:3916 N INTERTECH CT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913
Practice Address - Country:US
Practice Address - Phone:920-996-1000
Practice Address - Fax:920-996-1054
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28574207Q00000X
WI28574-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31485700Medicaid
WIK300307094Medicare PIN
WIE46129Medicare UPIN
WI31485700Medicaid
E46129Medicare UPIN