Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2030 | ME |
NPI | 1649481433 |
---|---|
Provider Name | Dr. Michael A Landrum |
First Address | Freeport, ME 04032-6145 |
Second Address | Edwards, CO 81632-2637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 15/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F66627 | (02) |