MEDICARE: DR. KRIS NORDBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	A48135	CA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD8274	HI
3	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	9300258	NC
4	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	9300258	NC

General Provider Information

NPI Number	:	1225097280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRIS NORDBERG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 30543
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27130-0543
Country	:	US
Telephone Number	:	704-213-0992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1695 KERNERSVILLE MEDICAL PKWY
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7159
Country	:	US
Telephone Number	:	336-515-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	09/13/2018

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