Healthcare Provider Details

I. General information

NPI: 1922042803
Provider Name (Legal Business Name): STEVEN N. LANDAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE FOOTE HOSPITAL ANESTHESIA DEPARTMENT
JACKSON MI
49201-1753
US

IV. Provider business mailing address

2443 DUNDEE DR
ANN ARBOR MI
48103-6022
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4963
  • Fax: 517-789-5903
Mailing address:
  • Phone: 734-994-5074
  • Fax: 734-769-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301049141
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG67394
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2368121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: