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Contact Information

CHARLES R NORDSTROM JR, MD
127 CANTERBURY RD
EAU CLAIRE, WI54701-7105
 Phone: 715-835-1884
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
Indicates primary specialty

NPI Profile & details for CHARLES R NORDSTROM JR · (Male)

NPI # 1528031069
Status Active
Credentials MD
Entity Individual
Enumeration date 02/07/2006
Last updated 01/31/2012 - About 14 years ago
Sole proprietor 1 Yes
Identifiers
  • WI License # 21796
  • WI Medicaid 30184300
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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