Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD-42827 | IA |
NPI | 1033554498 |
---|---|
Provider Name | Matthew John Landherr |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Cedar Rapids, IA 52403-2420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 20/09/2021 |