MEDICARE: DR. BRIDGET NORD 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	207Q00000X	Family Medicine Physician	036-138845	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538435763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIDGET NORD M.D.

Provider Business Mailing Address
First Line	:	1431 N WESTERN AVE
Second Line	:	SUITE 401
City	:	CHICAGO
State	:	IL
Zip	:	60622-1797
Country	:	US
Telephone Number	:	312-498-3284
Fax Number	:	312-491-5485

Provider Business Practice Location Address
First Line	:	1649 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-5207
Country	:	US
Telephone Number	:	773-278-6868
Fax Number	:	773-278-6922

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

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	02/22/2016

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