Mark Landt, D.O.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

34-00-3644 Issued in OH

Practice address

37 Elk Place
Edwards, CO 81632-0722

Phone

(970) 926-5702

NPI assigned

Jun 14, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426809600000",
    "number": "1477558856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 722",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "816320722",
            "telephone_number": "970-926-5702",
            "fax_number": "970-926-5702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 ELK PLACE",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "816320722",
            "telephone_number": "970-926-5702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDT",
        "first_name": "MARK",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2015-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "34-00-3644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN#",
            "identifier": "000000024299",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0553995",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNHC PIN#",
            "identifier": "20-00775",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS PIN#",
            "identifier": "050045148",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renata Kubina, MEDICAL MASSAGE PRAC
• Kerrie Kuhl, CNM
• Emily Susanne Kunkel, LCSW, MSW,
• Christine Elizabeth Labadie, D.C.
• Courtney Lambrecht, PHARMD
• Kaitlin Bligh Lavin, ATC, L
• Blaine Nicole Lawson, LPC
• Dianne C. Leeb, M.D.
• Lorie Ann Lengyel, OTR/L
• Valerie J Lessard Cook, LMT, MMP

• All providers in Edwards, CO
• Anesthesiology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; 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.