Provider Demographics
NPI:1235346016
Name:R. KENNETH LANDOW, M.D. LTD
Entity Type:Organization
Organization Name:R. KENNETH LANDOW, M.D. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:R.
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:LANDOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-451-3376
Mailing Address - Street 1:10080 ALTA DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8723
Mailing Address - Country:US
Mailing Address - Phone:702-451-3376
Mailing Address - Fax:702-451-0041
Practice Address - Street 1:10080 ALTA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8723
Practice Address - Country:US
Practice Address - Phone:702-451-3376
Practice Address - Fax:702-451-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2002054Medicaid
NVC96256Medicare UPIN
NV2002054Medicaid