Provider Demographics
NPI:1407850225
Name:NORBERG, JON DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DAVID
Last Name:NORBERG
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 1:9325 UPLAND LN N STE 255
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4463
Mailing Address - Country:US
Mailing Address - Phone:763-465-4263
Mailing Address - Fax:763-314-2026
Practice Address - Street 1:9325 UPLAND LN N STE 255
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4463
Practice Address - Country:US
Practice Address - Phone:763-465-4263
Practice Address - Fax:763-314-2026
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9161207X00000X, 2086S0105X
MN634192086S0105X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN278676100Medicaid
NDNOR24461OtherND BLUE SHIELD
ND12017Medicaid
MN63419OtherPROFESSIONAL LICENSE
NDP00139507OtherPALMETTO GBA-RR MEDICARE
MN307M9NOOtherMN BLUE SHIELD
NDP00139507OtherPALMETTO GBA-RR MEDICARE
ND12017Medicaid
MN278676100Medicaid