Provider Demographics
NPI:1265402507
Name:BARGSTADT, MICHAEL G (MSPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:BARGSTADT
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1533
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-1533
Mailing Address - Country:US
Mailing Address - Phone:712-234-8760
Mailing Address - Fax:712-234-8765
Practice Address - Street 1:317 DAKOTA DUNES BLVD STE D
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5341
Practice Address - Country:US
Practice Address - Phone:605-242-5016
Practice Address - Fax:605-242-5018
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02846208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5831823OtherTITLE 19
IA214924Medicaid
NE42147982000OtherTITLE 19
NE42147982000OtherTITLE 19
S79226Medicare UPIN
SD101554Medicare PIN