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General NPI Number Information
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NPI Number | 1487892436
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Entity Type | Organization
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Legal Business Name | LANDRA PROSTHETICS AND ORTHOTICS, INC
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 526 N TELEGRAPH RD
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City | MONROE
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State | MI
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Zip | 48162-3337
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Country | US
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Telephone | 734-242-4050
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Fax | 734-242-4090
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Provider Business Mailing Address
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Address Line | PO BOX 34
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City | TRENTON
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State | MI
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Zip | 48183-0034
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Country | US
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Telephone | 734-242-4050
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Fax | 734-242-4090
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVEN JAMES LANDRA
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Credential | CPO
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Telephone | 734-242-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | AME-0163611
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | AME-0163611
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License Number State | MI
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