Provider Demographics
NPI:1225139918
Name:LANDERS, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:LANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20825 MACK AVE
Mailing Address - Street 2:#4
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-881-6900
Mailing Address - Fax:313-881-7267
Practice Address - Street 1:20825 MACK AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-881-6982
Practice Address - Fax:313-881-7267
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIJL406104208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4695560Medicaid
MI4695560Medicaid