MEDICARE: MICHAEL LANGHAM PA-C

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	363A00000X	Physician Assistant	PA9101337	FL
2	363A00000X	Physician Assistant	PA 9101337	FL

General Provider Information

NPI Number	:	1588774905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LANGHAM PA-C

Provider Business Mailing Address
First Line	:	465 BRADFORD LN
Second Line	:
City	:	AURORA
State	:	OH
Zip	:	44202-8587
Country	:	US
Telephone Number	:	239-633-5352
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIT 28037 BOX PSC
Second Line	:
City	:	APO
State	:	AE
Zip	:	09112-8037
Country	:	US
Telephone Number	:	239-633-5352
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/14/2025

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Directions to “ MICHAEL LANGHAM PA-C” Practice Location

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