Provider Demographics
NPI:1104217074
Name:LANDESMAN, DONALD JOE (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOE
Last Name:LANDESMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9277 BURNING TREE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9515
Mailing Address - Country:US
Mailing Address - Phone:810-252-1553
Mailing Address - Fax:
Practice Address - Street 1:9277 BURNING TREE DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-9515
Practice Address - Country:US
Practice Address - Phone:810-252-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3507207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology