Healthcare Provider Details

I. General information

NPI: 1225139918
Provider Name (Legal Business Name): JAMES M LANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20825 MACK AVE SUITE 4
GROSSE POINTE WOODS MI
48236
US

IV. Provider business mailing address

20825 MACK AVE #4
GROSSE POINTE WOODS MI
48236
US

V. Phone/Fax

Practice location:
  • Phone: 313-881-6982
  • Fax: 313-881-7267
Mailing address:
  • Phone: 313-881-6900
  • Fax: 313-881-7267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJL406104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: