MEDICARE: DR. JENNIFER L LANDRIGAN 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	208000000X	Pediatrics Physician	01044734A	IN

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	:	1225032642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER L LANDRIGAN MD

Provider Business Mailing Address
First Line	:	7910 W JEFFERSON BLVD
Second Line	:	STE 201
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4159
Country	:	US
Telephone Number	:	260-436-3789
Fax Number	:	260-436-2703

Provider Business Practice Location Address
First Line	:	7910 W JEFFERSON BLVD
Second Line	:	STE 201
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4159
Country	:	US
Telephone Number	:	260-436-3789
Fax Number	:	260-436-2703

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/22/2008

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