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General NPI Number Information
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NPI Number | 1659341295
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Entity Type | Individual
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Provider Name | IVAN R LANDAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 557 SEMINOLE RD
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City | NORTON SHORES
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State | MI
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Zip | 49444-3719
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Country | US
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Telephone | 231-722-7510
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Fax | 231-722-7513
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Provider Business Mailing Address
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Address Line | 557 SEMINOLE RD
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City | NORTON SHORES
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State | MI
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Zip | 49444-3719
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Country | US
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Telephone | 231-722-7510
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Fax | 231-722-7513
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 048973
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License Number State | MI
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