Provider Demographics
NPI:1104855501
Name:LANDES, PATRICK JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:LANDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:JAMES
Other - Last Name:LANDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1303 SW FIRST AMERICAN PL
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-4059
Mailing Address - Country:US
Mailing Address - Phone:785-234-2306
Mailing Address - Fax:785-234-2550
Practice Address - Street 1:1303 SW FIRST AMERICAN PL
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-4059
Practice Address - Country:US
Practice Address - Phone:785-234-2306
Practice Address - Fax:785-234-2550
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-271962085R0202X
NE2222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100290960CMedicaid
KS052483OtherBC/BS PREMIER BLUE
KS052483OtherBC/BS PREMIER BLUE
KS052483Medicare PIN