Provider Demographics
NPI:1013999242
Name:NYGREN, LINDA J (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:NYGREN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2545 CHICAGO AVENUE SOUTH
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4544
Mailing Address - Country:US
Mailing Address - Phone:612-871-5511
Mailing Address - Fax:612-871-0996
Practice Address - Street 1:2545 CHICAGO AVENUE SOUTH
Practice Address - Street 2:SUITE 405
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4544
Practice Address - Country:US
Practice Address - Phone:612-871-5511
Practice Address - Fax:612-871-0996
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2010-05-21
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Provider Licenses
StateLicense IDTaxonomies
WI43580208000000X
MN28967208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1013999242Medicaid
WI30628600Medicaid
E90951Medicare UPIN
WI30628600Medicaid