Healthcare Provider Details

I. General information

NPI: 1316054869
Provider Name (Legal Business Name): MEGAN LANDAUER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 TOWNLINE RD
MINOCQUA WI
54548-1390
US

IV. Provider business mailing address

189 E RAILROAD ST
VERONA WI
53593-1846
US

V. Phone/Fax

Practice location:
  • Phone: 715-358-1000
  • Fax:
Mailing address:
  • Phone: 920-420-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number24969
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number147717
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: