Provider Demographics
NPI:1629327994
Name:MICHAEL D. LANDMAN, M.D., INC.
Entity Type:Organization
Organization Name:MICHAEL D. LANDMAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-609-0600
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-609-0600
Mailing Address - Fax:818-609-1680
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-609-0600
Practice Address - Fax:818-609-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22817261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A228170Medicaid
CA00A228170Medicaid