Provider Demographics
NPI:1457397143
Name:LANDESMAN, NATHAN JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JOSEPH
Last Name:LANDESMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HEALTH PARK BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2558
Mailing Address - Country:US
Mailing Address - Phone:810-603-8400
Mailing Address - Fax:810-603-8410
Practice Address - Street 1:600 HEALTH PARK BLVD STE D
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2558
Practice Address - Country:US
Practice Address - Phone:810-603-8400
Practice Address - Fax:810-603-8410
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015229207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4551874Medicaid
WI738440086Medicare PIN
WI650030039Medicare PIN
MI4551874Medicaid