Provider Demographics
NPI:1104853613
Name:NORDLUND, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:NORDLUND
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 1:1945 CEI DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3311
Mailing Address - Country:US
Mailing Address - Phone:513-984-5133
Mailing Address - Fax:513-569-3741
Practice Address - Street 1:1945 CEI DRIVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3311
Practice Address - Country:US
Practice Address - Phone:513-984-5133
Practice Address - Fax:513-984-4240
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078181207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00217688OtherRR MEDICARE
IN200345610Medicaid
KY64017205Medicaid
OH2215525Medicaid
000000111066OtherBCBS
IN180044759OtherRR MEDICARE
OH4024653Medicare PIN
HI8352Medicare UPIN
OHP00217688OtherRR MEDICARE
KY64017205Medicaid
IN200345610Medicaid