Healthcare Provider Details

I. General information

NPI: 1679923155
Provider Name (Legal Business Name): ELISE JENNIFER LANDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S WASHINGTON AVE STE E
SAGINAW MI
48601-2556
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-907-7636
  • Fax: 989-907-7584
Mailing address:
  • Phone: 989-839-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301110256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: