Provider Demographics
NPI:1689343600
Name:ADVANCED HAND AND UPPER EXTREMITY CENTER PC
Entity Type:Organization
Organization Name:ADVANCED HAND AND UPPER EXTREMITY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NORBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-465-4263
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:
Practice Address - Street 1:9325 UPLAND LN N # 255
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:701-388-2196
Practice Address - Fax:763-314-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12017Medicaid
MN63419OtherPROFESSIONAL LICENSE