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NPI Code Detail

MEDICARE: JESSE J LANDHUIS MD

MEDICARE: JESSE J LANDHUIS 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
1207Q00000XFamily Medicine Physician4301077193MI

General Provider Information

NPI Number : 1255431920
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE J LANDHUIS MD
Provider Business Mailing Address
First Line : PO BOX 10
Second Line :
City : MASON
State : MI
Zip : 48854-0010
Country : US
Telephone Number : 517-676-9788
Fax Number : 517-676-3438
Provider Business Practice Location Address
First Line : 5135 S PENNSYLVANIA AVE
Second Line :
City : LANSING
State : MI
Zip : 48911-4002
Country : US
Telephone Number : 517-887-5922
Fax Number : 517-887-5982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2006
Last Update Date : 03/04/2008

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