Gregoria B Landicho, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01043004A Issued in IN

Practice address

1501 Wabash
Suite #202
Michigan City, IN 46360

Phone

(219) 877-1965

Fax

(219) 877-1066

NPI assigned

Sep 19, 2005

Last updated

Nov 23, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healthpartners Medical Group, LLC

  dba HealthPartners

  • Multi-Specialty Clinic/Center
  • Michigan City, IN
  • NPI 1013014158
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322006400000",
    "number": "1407841216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 SIERRA DR",
            "address_2": "STE 400",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461437240",
            "telephone_number": "317-528-4248",
            "fax_number": "317-865-8314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 WABASH",
            "address_2": "SUITE #202",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "46360",
            "telephone_number": "219-877-1965",
            "fax_number": "219-877-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDICHO",
        "first_name": "GREGORIA",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-19",
        "last_updated": "2011-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01043004A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200046900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lakeshore Cardiovascular Institute LLC
• Lakeshore Eye Consultants, LLC (Lakeshore Eye Consultants)
• Lakeshore Eye Specialists PC
• Lakeshore Family Dental, P.C.
• Lakeshore Interventional Pain Associates, LLC
• Christie Ann Lant, DDS
• Laporte County Comprehensive Mental Health Council (Swanson Center)
• Laporte County Comprehensive Mental Health Council (Swanson Center)
• Laporte Regional Health System (LaPorte Hospital Home Medical Equipment)
• Laporte Regional Health System, Inc. (LaPorte Hospital Home Medical Equipment)

• Pediatrics Physician in Michigan City, IN
• Providers in Michigan City, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.