Provider Demographics
NPI:1679201578
Name:NORDIC FAMILY MEDICINE PC
Entity type:Organization
Organization Name:NORDIC FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:ERIK
Authorized Official - Last Name:BJELLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-318-4407
Mailing Address - Street 1:5621 36TH AVE S UNIT 200
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5270
Mailing Address - Country:US
Mailing Address - Phone:701-977-9277
Mailing Address - Fax:
Practice Address - Street 1:5621 36TH AVE S UNIT 200
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5270
Practice Address - Country:US
Practice Address - Phone:701-977-9277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty