Healthcare Provider Details

I. General information

NPI: 1578569810
Provider Name (Legal Business Name): ELLIOT N LANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 S DIXIE HWY
MIAMI FL
33176-7224
US

IV. Provider business mailing address

11767 S DIXIE HWY SUITE 357
MIAMI FL
33156-4438
US

V. Phone/Fax

Practice location:
  • Phone: 786-342-8082
  • Fax: 800-404-0732
Mailing address:
  • Phone: 786-342-8082
  • Fax: 800-404-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME36255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: