Healthcare Provider Details

I. General information

NPI: 1689343600
Provider Name (Legal Business Name): ADVANCED HAND AND UPPER EXTREMITY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 08/21/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 UPLAND LN N # 255
MAPLE GROVE MN
55369
US

IV. Provider business mailing address

9325 UPLAND LN N STE 255
MAPLE GROVE MN
55369-4463
US

V. Phone/Fax

Practice location:
  • Phone: 701-388-2196
  • Fax: 763-314-2026
Mailing address:
  • Phone: 763-465-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JON DAVID NORBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 763-465-4263