Individual
VICTORIA LYNN LANDOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4717 SAINT ANTOINE ST, DETROIT, MI 48201-1423
(313) 577-8900
(313) 577-0700
Mailing address
1560 E MAPLE RD, SUITE 400-CREDENTIALING, TROY, MI 48083-1138
(313) 577-8900
(313) 577-0700
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
5101015289
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5101015289
MI LICENSE
MI
Enumeration date
08/17/2006
Last updated
10/25/2016
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