Provider Demographics
NPI:1922042803
Name:LANDAU, STEVEN N (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:N
Last Name:LANDAU
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 1:2443 DUNDEE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6022
Mailing Address - Country:US
Mailing Address - Phone:734-994-5074
Mailing Address - Fax:734-769-0178
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:FOOTE HOSPITAL ANESTHESIA DEPARTMENT
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-788-4963
Practice Address - Fax:517-789-5903
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049141207L00000X
CAG67394207L00000X
NY2368121207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2736261Medicaid
MI3461997Medicaid
C86047001Medicare ID - Type Unspecified
E43332Medicare UPIN