Healthcare Provider Details

I. General information

NPI: 1821292087
Provider Name (Legal Business Name): LARS BJOERNSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LARS PETTER BACHE-WIIG BJORNSEN M.D.

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STABELLSVEI 7A
TRONDHEIM SOR-TRONDELAG
7021
NO

IV. Provider business mailing address

2051 ALLEN BLVD APT 201
MIDDLETON WI
53562-3456
US

V. Phone/Fax

Practice location:
  • Phone: 0114793212617
  • Fax:
Mailing address:
  • Phone: 608-556-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number52690-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: