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NPI Code Detail

MEDICARE: MATTHEW A LANGE DO

MEDICARE:   MATTHEW A LANGE  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician2018016254MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063775716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW A LANGE DO
Provider Business Mailing Address
First Line : 1000 DES PERES RD STE 120
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63131-2062
Country : US
Telephone Number : 314-887-7605
Fax Number : 314-887-7609
Provider Business Practice Location Address
First Line : 1000 DES PERES RD STE 120
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63131-2062
Country : US
Telephone Number : 314-887-7605
Fax Number : 314-887-7609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2012
Last Update Date : 03/16/2026

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Directions to “ MATTHEW A LANGE DO” Practice Location

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