Provider Demographics
NPI:1972926871
Name:LANDGREN, CARL (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:LANDGREN
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 1:1475 NW 12TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1002
Mailing Address - Country:US
Mailing Address - Phone:305-243-5302
Mailing Address - Fax:305-243-9161
Practice Address - Street 1:1475 NW 12TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1002
Practice Address - Country:US
Practice Address - Phone:305-243-5302
Practice Address - Fax:305-243-9161
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280052207RH0003X
MDD0048409207RH0003X
FLME147425207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology