MEDICARE: DR. ROBERT A NORDLAND 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	207V00000X	Obstetrics & Gynecology Physician	LL726	FL
2	207V00000X	Obstetrics & Gynecology Physician	19812	MN

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	:	1669460077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A NORDLAND M.D.

Provider Business Mailing Address
First Line	:	550 S MAPLE ST
Second Line	:
City	:	WACONIA
State	:	MN
Zip	:	55387-1763
Country	:	US
Telephone Number	:	952-442-2137
Fax Number	:	952-442-5960

Provider Business Practice Location Address
First Line	:	2355 STANFORD CT UNIT 701
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-4813
Country	:	US
Telephone Number	:	239-566-7425
Fax Number	:	239-593-3430

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/21/2022

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