Healthcare Provider Details

I. General information

NPI: 1932275088
Provider Name (Legal Business Name): NOREN BRADLY MELAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 S WASHINGTON ST - ALTRU PROFESSIONAL CENTER
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-7700
  • Fax: 701-780-1942
Mailing address:
  • Phone: 701-781-1891
  • Fax: 701-780-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number28419
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number11155
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: