Healthcare Provider Details

I. General information

NPI: 1578646063
Provider Name (Legal Business Name): AMY LANDAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E STE 300
ROCHESTER HILLS MI
48307-6120
US

IV. Provider business mailing address

1701 SOUTH BLVD E STE 300
ROCHESTER HILLS MI
48307-6120
US

V. Phone/Fax

Practice location:
  • Phone: 248-884-9710
  • Fax: 248-884-9711
Mailing address:
  • Phone: 248-884-9710
  • Fax: 248-884-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004172
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: