Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 0101244851 | VA |
N | 2086S0129X | Vascular Surgeon | 01056946A | IN |
NPI | 1083709737 |
---|---|
Provider Name | Michael E Landis |
First Address | Williamsburg, VA 23188-5716 |
Second Address | Williamsburg, VA 23188-5716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F84530 | (02) | IN |