Provider Demographics
NPI:1538435763
Name:NORD, BRIDGET (MD)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:
Last Name:NORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1797
Mailing Address - Country:US
Mailing Address - Phone:312-498-3284
Mailing Address - Fax:312-491-5485
Practice Address - Street 1:1649 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-5207
Practice Address - Country:US
Practice Address - Phone:773-278-6868
Practice Address - Fax:773-278-6922
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-138845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036138845Medicaid
ILF400259811Medicare Oscar/Certification