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General NPI Number Information
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NPI Number | 1033223730
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Entity Type | Individual
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Provider Name | MICHAEL D LANDERS DO
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 10507 E 91ST ST STE 450
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City | TULSA
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State | OK
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Zip | 74133-5515
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Country | US
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Telephone | 918-307-3170
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Fax | 918-307-3171
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Provider Business Mailing Address
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Address Line | 6600 S YALE AVE STE 1400
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City | TULSA
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State | OK
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Zip | 74136-3331
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N3810
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | N3810
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | N3810
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 19051
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License Number State | MS
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Taxonomy #5
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 3862
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License Number State | OK
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