Provider Demographics
NPI:1679287767
Name:LESLEY V LANDIS MD PLLC
Entity Type:Organization
Organization Name:LESLEY V LANDIS MD PLLC
Other - Org Name:LANDIS PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-650-3452
Mailing Address - Street 1:2005 E 21ST ST STE 325
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1403
Mailing Address - Country:US
Mailing Address - Phone:918-764-8516
Mailing Address - Fax:918-764-8514
Practice Address - Street 1:2005 E 21ST ST STE 325
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1403
Practice Address - Country:US
Practice Address - Phone:918-764-8516
Practice Address - Fax:918-764-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty