1538954508 NPI number — JAMES THOMAS MACMILLAN LANDEFELD

Table of content: JAMES THOMAS MACMILLAN LANDEFELD (NPI 1538954508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538954508 NPI number — JAMES THOMAS MACMILLAN LANDEFELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDEFELD
Provider First Name:
JAMES
Provider Middle Name:
THOMAS MACMILLAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538954508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1685 HIGHLAND AVENUE
Provider Second Line Business Mailing Address:
5158 MEDICAL FOUNDATION CENTENNIAL BUILDING
Provider Business Mailing Address City Name:
SHOREWOOD HILLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53705-2281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-263-1300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1685 HIGHLAND AVENUE
Provider Second Line Business Practice Location Address:
5158 MEDICAL FOUNDATION CENTENNIAL BUILDING
Provider Business Practice Location Address City Name:
SHOREWOOD HILLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53705-2281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-263-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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