Basic Information
| Provider Information | |||||||||
| NPI: | 1275573826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANDE | ||||||||
| FirstName: | ARNOLD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3201 SNELLING AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554062431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124144011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 824 N 11TH ST | ||||||||
| Address2: | |||||||||
| City: | MONTEVIDEO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562651629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202698877 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 31607 | MN | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 31061 | WI | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 31775800 | 05 | WI | MEDICAID |