Active NPI
Brad Allan Landis, AT, ATC
- Athletic Trainer
- Wells, MI
National Provider Identifier
1457098279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2601000332
- Practice address
- 6412 N 8TH St
Wells, MI 49894-9735 - Phone
- (906) 450-0475
- NPI assigned
- May 13, 2022
- Last updated
- May 13, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2601000332 | MI | Primary |
Addresses
Primary practice location
6412 N 8TH St
Wells, MI 49894-9735
Mailing address
3401 Ludington St
Escanaba, MI 49829-1300
Phone (906) 786-5707
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2601000332 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652400000000",
"number": "1457098279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3401 LUDINGTON ST",
"city": "ESCANABA",
"state": "MI",
"postal_code": "498291300",
"telephone_number": "906-786-5707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6412 N 8TH ST",
"city": "WELLS",
"state": "MI",
"postal_code": "498949735",
"telephone_number": "906-450-0475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDIS",
"first_name": "BRAD",
"middle_name": "ALLAN",
"credential": "AT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-13",
"last_updated": "2022-05-13",
"certification_date": "2022-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "2601000332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wells, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.