Provider Demographics
NPI:1336144955
Name:NORD, DANIEL ALBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALBERT
Last Name:NORD
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 1:1505 EASTLAND DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7906
Mailing Address - Country:US
Mailing Address - Phone:309-663-8888
Mailing Address - Fax:309-663-9544
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:SUITE 230
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7906
Practice Address - Country:US
Practice Address - Phone:309-663-8888
Practice Address - Fax:309-663-9544
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064021207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064021Medicaid
IL05700259OtherBCBS OF IL
IL05700259OtherBCBS OF IL
C41705Medicare UPIN
IL685440Medicare ID - Type Unspecified