Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 44210 | MN |
NPI | 1548264435 |
---|---|
Provider Name | Timothy Alan Lander |
First Address | Minneapolis, MN 55404-4549 |
Second Address | Minneapolis, MN 55404-4549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H60551 | (02) |