Provider Demographics
NPI:1548264435
Name:LANDER, TIMOTHY ALAN (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALAN
Last Name:LANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:910 E 26TH ST
Mailing Address - Street 2:STE 323
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4549
Mailing Address - Country:US
Mailing Address - Phone:612-874-1292
Mailing Address - Fax:612-874-0985
Practice Address - Street 1:910 E 26TH ST
Practice Address - Street 2:STE 323
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4549
Practice Address - Country:US
Practice Address - Phone:612-874-1292
Practice Address - Fax:612-874-0985
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN44210207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60551Medicare UPIN