Provider Demographics
NPI:1083689236
Name:LANDES, FRED S (MD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:S
Last Name:LANDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:3015 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5418
Practice Address - Country:US
Practice Address - Phone:605-725-1700
Practice Address - Fax:605-725-1761
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4290207L00000X
ND12144207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050071558OtherRR MEDICARE
ND10367Medicaid
050071558OtherRR MEDICARE
SDS5237Medicare PIN
NDN717452Medicare PIN
C89122Medicare UPIN