Provider Demographics
NPI:1184824088
Name:LANDAU, EVAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:M
Last Name:LANDAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-5365
Practice Address - Fax:954-468-5251
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2435542085R0001X
FLME1093362085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL662325OtherWELLCARE
FL01671620OtherAMERIGROUP
FL7422OtherDIMENSIONS
FLP997247OtherFREEDOM HEALTH
FL9414789OtherAETNA
FLP00990539OtherRAILROAD MEDICARE
FL003841600Medicaid
FL14EC7OtherBCBS FL
FL349267OtherAVMED
FL2295602OtherGHI
FLF00335716002OtherUNITED HEALTHCARE
FL23340OtherMEDICA
FL2810412OtherCIGNA
FLP0003152OtherFLORIDA HEALTHCARE PLUS
FLP938024OtherOPTIMUN
FLP938024OtherOPTIMUN
FL23340OtherMEDICA