Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 01027533A | IN |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 01027533A | IN |
NPI | 1144212317 |
---|---|
Provider Name | Ronald J Landin |
First Address | Fort Wayne, IN 46825-1545 |
Second Address | Fort Wayne, IN 46845-1730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000641090 | ANTHEM (01) | IN |
060070572 | RR MEDICARE (01) | IN |
0917584 | (05) | OH |
100341860 | (05) | IN |
D94555 | (02) | IN |
P00786838 | R.R. MEDICARE (01) | IN |