Provider Demographics
NPI:1831127430
Name:LANDAU, CHAVA SHIFRA (CRNA)
Entity Type:Individual
Prefix:
First Name:CHAVA
Middle Name:SHIFRA
Last Name:LANDAU
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHAVASHIFRA
Other - Middle Name:
Other - Last Name:LANDAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:6850 HOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-1410
Mailing Address - Country:US
Mailing Address - Phone:219-937-5067
Mailing Address - Fax:219-937-5094
Practice Address - Street 1:6836 HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-1499
Practice Address - Country:US
Practice Address - Phone:219-937-5063
Practice Address - Fax:219-937-5093
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003389207L00000X
IN28120369A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL332567000001Medicaid
IL332567000001Medicaid