Provider Demographics
NPI:1285893370
Name:LANDWEHR, CHAD A (PA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:A
Last Name:LANDWEHR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226070 CLEARVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476
Mailing Address - Country:US
Mailing Address - Phone:715-301-5615
Mailing Address - Fax:715-997-8663
Practice Address - Street 1:226070 CLEARVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476
Practice Address - Country:US
Practice Address - Phone:715-574-5101
Practice Address - Fax:715-997-8663
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2265-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty