MEDICARE: DR. JOHN T LANDERS JR. M.D.

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	207N00000X	Dermatology Physician	036174729	IL
2	207N00000X	Dermatology Physician	22066	WV

General Provider Information

NPI Number	:	1578533493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN T LANDERS JR. M.D.

Provider Business Mailing Address
First Line	:	2701 PATRIOT BLVD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8039
Country	:	US
Telephone Number	:	847-535-7664
Fax Number	:	847-998-9303

Provider Business Practice Location Address
First Line	:	2701 PATRIOT BLVD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8039
Country	:	US
Telephone Number	:	847-535-7664
Fax Number	:	847-998-9071

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	12/22/2025

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