MEDICARE: MARK WARREN LANGLEY

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
1	390200000X	Student in an Organized Health Care Education/Training Program	4351055753	MI

General Provider Information

NPI Number	:	1336982305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WARREN LANGLEY

Provider Business Mailing Address
First Line	:	300 N INGALLS ST
Second Line	:	NI4C06
City	:	ANN ARBOR
State	:	MI
Zip	:	48109-5435
Country	:	US
Telephone Number	:	734-615-2690
Fax Number	:

Provider Business Practice Location Address
First Line	:	14700 E OLD US HIGHWAY 12
Second Line	:
City	:	CHELSEA
State	:	MI
Zip	:	48118-1185
Country	:	US
Telephone Number	:	734-615-2690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	05/14/2026

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