Provider Demographics
NPI:1972571099
Name:PIETRYGA, TERRY E (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:E
Last Name:PIETRYGA
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 1:3570 SUNNINGDALE DR N
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9772
Mailing Address - Country:US
Mailing Address - Phone:810-252-2194
Mailing Address - Fax:
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0856682085R0202X
PA4355702085R0202X
MI43010720962085R0202X
IN01060109A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4692907Medicaid
OHP00191476OtherRAILROAD MEDICARE
OH000000354582OtherANTHEM BCBS
OH2535411Medicaid
MI4692916Medicaid
MI4692961Medicaid
MI4692952Medicaid
H79993Medicare UPIN
MI4692916Medicaid
MI4692952Medicaid
OH000000354582OtherANTHEM BCBS
OH4151431Medicare ID - Type Unspecified
OH2535411Medicaid