Provider Demographics
NPI:1942679600
Name:MONTE NORGAARD MD PA
Entity Type:Organization
Organization Name:MONTE NORGAARD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-351-7079
Mailing Address - Street 1:12747 53RD ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-1051
Mailing Address - Country:US
Mailing Address - Phone:651-351-7079
Mailing Address - Fax:
Practice Address - Street 1:12747 53RD ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-1051
Practice Address - Country:US
Practice Address - Phone:651-351-7079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34156207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1295702215Medicare PIN