MEDICARE: LANDI MARIE CRANSTOUN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2014-02032	NC
2	207Q00000X	Family Medicine Physician	47874	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144482456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANDI MARIE CRANSTOUN MD

Provider Business Mailing Address
First Line	:	496 SOUTHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1827
Country	:	US
Telephone Number	:	859-288-2392
Fax Number	:	859-721-3918

Provider Business Practice Location Address
First Line	:	103 ALYCIA DR STE 2
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2368
Country	:	US
Telephone Number	:	606-330-7818
Fax Number	:	606-330-7825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	02/25/2021

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