Individual
DR. MICHAEL LEROY LANDRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 433-3456
(920) 433-3469
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
01054143A
IN
207RI0200X
Infectious Disease Physician
4301503113
MI
207RI0200X
Infectious Disease Physician
Primary
56939
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ABIM-MOC
AMERICAN BOARD OF INTERNAL MEDICINE/INFECTIOUS DISEASE
—
Enumeration date
10/17/2006
Last updated
01/20/2023
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