1821292087 NPI number — DR. LARS BJOERNSEN M.D.

Table of content: DR. LARS BJOERNSEN M.D. (NPI 1821292087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821292087 NPI number — DR. LARS BJOERNSEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BJOERNSEN
Provider First Name:
LARS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BJORNSEN
Provider Other First Name:
LARS PETTER
Provider Other Middle Name:
BACHE-WIIG
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821292087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2051 ALLEN BLVD
Provider Second Line Business Mailing Address:
APT 201
Provider Business Mailing Address City Name:
MIDDLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53562-3456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-556-8214
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STABELLSVEI 7A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRONDHEIM
Provider Business Practice Location Address State Name:
SOR-TRONDELAG
Provider Business Practice Location Address Postal Code:
7021
Provider Business Practice Location Address Country Code:
NO
Provider Business Practice Location Address Telephone Number:
0114793212617
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  52690-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)