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NPI Code Detail

MEDICARE: DR. ELISE JENNIFER LANDA M.D.

MEDICARE: DR. ELISE JENNIFER LANDA 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
1207R00000XInternal Medicine Physician4301110256MI

General Provider Information

NPI Number : 1679923155
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELISE JENNIFER LANDA M.D.
Provider Business Mailing Address
First Line : 4000 WELLNESS DR
Second Line :
City : MIDLAND
State : MI
Zip : 48670-2000
Country : US
Telephone Number : 989-839-3000
Fax Number :
Provider Business Practice Location Address
First Line : 1015 S WASHINGTON AVE STE E
Second Line :
City : SAGINAW
State : MI
Zip : 48601-2556
Country : US
Telephone Number : 989-907-7636
Fax Number : 989-907-7584
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2016
Last Update Date : 05/04/2026

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