Provider Demographics
NPI:1588665780
Name:LANDGARTEN, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LANDGARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 COLORADO BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6884
Mailing Address - Country:US
Mailing Address - Phone:940-320-1708
Mailing Address - Fax:940-565-5457
Practice Address - Street 1:6190 LYNDON B JOHNSON FWY
Practice Address - Street 2:702
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6344
Practice Address - Country:US
Practice Address - Phone:214-466-7230
Practice Address - Fax:214-466-7236
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-02-01
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXM0142207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173737103Medicaid
TX523340YWSHMedicare PIN
TX523340YWSHMedicare PIN
TXH56976Medicare UPIN
TXTXB110063Medicare PIN
TX8S2610OtherBCBS