Provider Demographics
NPI:1447275979
Name:RYDBERG, MITCHEL LESTER
Entity type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:LESTER
Last Name:RYDBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MITCHEL
Other - Middle Name:LESTER
Other - Last Name:RYDBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:24562 473 AVE
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022
Mailing Address - Country:US
Mailing Address - Phone:605-336-3230
Mailing Address - Fax:605-333-5387
Practice Address - Street 1:2501 W 22ST
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:SIOUXF FALLS
Practice Address - State:SD
Practice Address - Zip Code:57022
Practice Address - Country:US
Practice Address - Phone:605-336-3230
Practice Address - Fax:605-333-5387
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine