Healthcare Provider Details

I. General information

NPI: 1023013018
Provider Name (Legal Business Name): BJORN ROLF BJORNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2547 STATE ROAD 35
LUCK WI
54853-4501
US

IV. Provider business mailing address

265 GRIFFIN STREET EAST AMERY REGIONAL MEDICAL CENTER
AMERY WI
54001-1439
US

V. Phone/Fax

Practice location:
  • Phone: 715-472-2177
  • Fax:
Mailing address:
  • Phone: 715-268-8000
  • Fax: 715-268-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27888
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: