Provider Demographics
NPI:1649290461
Name:NORD, LAWRENCE A (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:NORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1505 EASTLAND DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3534
Mailing Address - Country:US
Mailing Address - Phone:309-662-2278
Mailing Address - Fax:309-663-2956
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:SUITE 220
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3534
Practice Address - Country:US
Practice Address - Phone:309-662-2278
Practice Address - Fax:309-663-2956
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-12-05
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Provider Licenses
StateLicense IDTaxonomies
IL036054037207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360540371OtherILL. DEPT OF PUBLIC AID
IL1302850001OtherADMINISTAR FEDERAL
IL5715378OtherBLUE CROSS BLUE SHIELD
IL257638OtherACORDIA NATIONAL
IL257638OtherHEALTHLINK
IL611952300OtherUS DEPARTMENT OF LABOR
IL791203417OtherMEDICARE METRAHEALTH
ILIL0101OtherJOHN DEERE HEALTH
IL036054037OtherUNITED HEALTHCARE
ILD14227OtherOSF CARE ADVANTAGE
ILK33554Medicare PIN