Provider Demographics
NPI:1902949787
Name:SIGRIN, MICHAEL EMANUEL (LP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EMANUEL
Last Name:SIGRIN
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1689 HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1126
Mailing Address - Country:US
Mailing Address - Phone:612-723-2900
Mailing Address - Fax:
Practice Address - Street 1:1689 HEWITT AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1126
Practice Address - Country:US
Practice Address - Phone:612-723-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3622103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist