MEDICARE: MICHAEL L NOORDSY PA-C

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	363A00000X	Physician Assistant	0563	SD

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	:	1871590281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL L NOORDSY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:	605-328-9556
Fax Number	:	605-328-9501

Provider Business Practice Location Address
First Line	:	1210 W 18TH ST
Second Line	:	STE LL03
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-4647
Country	:	US
Telephone Number	:	605-328-1410
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	06/19/2012

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