Provider Demographics
NPI:1679779227
Name:LANDGRAF, LAURA MARGARET (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARGARET
Last Name:LANDGRAF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 WAUKEGAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1885
Mailing Address - Country:US
Mailing Address - Phone:847-444-5328
Mailing Address - Fax:847-267-0694
Practice Address - Street 1:2151 WAUKEGAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1885
Practice Address - Country:US
Practice Address - Phone:847-444-5328
Practice Address - Fax:847-267-0694
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical