Provider Demographics
NPI:1265509350
Name:LANDIS PLASTIC SURGERY P C
Entity type:Organization
Organization Name:LANDIS PLASTIC SURGERY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-562-5940
Mailing Address - Street 1:2805 CAMPUS DRIVE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441
Mailing Address - Country:US
Mailing Address - Phone:952-562-5940
Mailing Address - Fax:952-562-5949
Practice Address - Street 1:109 BUSHAWAY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1945
Practice Address - Country:US
Practice Address - Phone:763-551-8985
Practice Address - Fax:763-551-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty