Healthcare Provider Details

I. General information

NPI: 1780668251
Provider Name (Legal Business Name): JAMES E LANG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 W FULLERTON AVE
CHICAGO IL
60647-2228
US

IV. Provider business mailing address

1431 N WESTERN AVE SUITE #406
CHICAGO IL
60622-1797
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-2229
  • Fax: 773-276-2190
Mailing address:
  • Phone: 312-633-5841
  • Fax: 312-491-5485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036077386
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: