Provider Demographics
NPI:1326876434
Name:LANDUM, KARA MARIE (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:LANDUM
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 2ND ST NW APT 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5002
Mailing Address - Country:US
Mailing Address - Phone:616-821-9186
Mailing Address - Fax:
Practice Address - Street 1:47405 KENNESAW RIDGE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317
Practice Address - Country:US
Practice Address - Phone:616-821-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health