Individual
DR. KEITH PETER LANDRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
51 EAST MARKET STREET, CLOVERDALE, IN 46120
(765) 795-4242
(765) 795-4456
Mailing address
PO BOX 508, CLOVERDALE, IN 46120-0508
(765) 795-4242
(765) 795-4456
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01057298A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000361385
ANTHEM BLUE CROSS & BLUE
IN
05
—
200818260F
—
IN
01
—
7289687
AETNA
IN
01
—
9339207
CIGNA
IN
Enumeration date
10/17/2005
Last updated
03/31/2021
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