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General NPI Number Information
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NPI Number | 1437417987
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Entity Type | Organization
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Legal Business Name | NORD MEDICAL WEIGHT LOSS CENTER
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 1505 EASTLAND DR SUITE 230
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3534
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Country | US
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Telephone | 309-661-1920
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 EASTLAND DR SUITE 230
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO, PHYSICIAN CONSULTANT
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Name | DR. DANIEL ALBERT NORD
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Credential | M.D.
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Telephone | 309-661-1920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 836064021
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License Number State | IL
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