Provider Demographics
NPI:1073564043
Name:NORDEEN, LOUIS WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:WILLIAM
Last Name:NORDEEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7481 RIGHT FLANK ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3838
Mailing Address - Country:US
Mailing Address - Phone:804-746-9797
Mailing Address - Fax:804-746-9794
Practice Address - Street 1:7481 RIGHT FLANK ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3838
Practice Address - Country:US
Practice Address - Phone:804-746-9797
Practice Address - Fax:804-746-9794
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300807213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0010113580Medicaid
VA480000728Medicare PIN
VAU82147Medicare UPIN