Provider Demographics
NPI:1023013018
Name:BJORNSON, BJORN ROLF (MD)
Entity Type:Individual
Prefix:DR
First Name:BJORN
Middle Name:ROLF
Last Name:BJORNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 GRIFFIN STREET EAST
Mailing Address - Street 2:AMERY REGIONAL MEDICAL CENTER
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1439
Mailing Address - Country:US
Mailing Address - Phone:715-268-8000
Mailing Address - Fax:715-268-0311
Practice Address - Street 1:2547 STATE ROAD 35
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853-4501
Practice Address - Country:US
Practice Address - Phone:715-472-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31424800Medicaid
WI0001-49170Medicare PIN
WI31424800Medicaid
WIB84704Medicare UPIN
WI0001Medicare ID - Type UnspecifiedSEQUENCE #
WI0015-00496Medicare PIN