| Organization Name: | LANDEN LAKE PEDIATRICS |
| NPI Number: | 1023029444 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN DOSCHER (OWNER) |
| Mailing Address: | 4834 Socialville Foster Rd Mason |
| State: | OH US |
| Postal Code: | 450406826 |
| Phone Number: | 5133985960 |
| Fax Number: | 5134597833 |
| NPI Enumeration Date: | 08/10/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |