Healthcare Provider Details

I. General information

NPI: 1083791123
Provider Name (Legal Business Name): ROBERT BJORK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 8TH AVE
KENOSHA WI
53143-5031
US

IV. Provider business mailing address

PO BOX 130
KENOSHA WI
53141-0130
US

V. Phone/Fax

Practice location:
  • Phone: 262-656-5542
  • Fax: 262-656-2749
Mailing address:
  • Phone: 262-656-2943
  • Fax: 262-656-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25903
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: