Provider Demographics
NPI:1194747543
Name:NORGARD, RANDALL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JOHN
Last Name:NORGARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:GOLDEN VALLEY
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:8290 UNIVERSITY AVE NE
Practice Address - Street 2:FRIDLEY
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1847
Practice Address - Country:US
Practice Address - Phone:763-786-9543
Practice Address - Fax:763-786-3320
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN27707207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
901550OtherMEDICA
969990266005OtherPREFERREDONE
HP14079OtherHEALTHPARTNERS
81650400OtherWISC MEDICAID
MN200001744Medicare ID - Type Unspecified
73B85NOOtherBLUE CROSS BLUE SHIELD
MNA10660Medicare UPIN
107326E949OtherUCARE
MN079892400Medicaid