Individual
CHAD R JUSTESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4023
(701) 234-4050
Mailing address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4023
(701) 234-4050
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
9230
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12073
—
ND
05
—
388675100
—
MN
Enumeration date
07/17/2006
Last updated
10/14/2008
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