Provider Demographics
NPI:1366647885
Name:BJORDAHL, PAUL M (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:BJORDAHL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:1508 W 22ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1514
Practice Address - Country:US
Practice Address - Phone:605-328-3840
Practice Address - Fax:605-328-3841
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2022-03-25
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Provider Licenses
StateLicense IDTaxonomies
MN55560208600000X
MN106189208600000X
SD8567208600000X
KS046765208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN020003270Medicare PIN