Provider Demographics
NPI:1194151753
Name:NORD, MICHAEL NELSON
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NELSON
Last Name:NORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6427 W GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1310
Mailing Address - Country:US
Mailing Address - Phone:414-449-3678
Mailing Address - Fax:414-449-3728
Practice Address - Street 1:6427 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1310
Practice Address - Country:US
Practice Address - Phone:414-449-3678
Practice Address - Fax:414-449-3728
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver