Healthcare Provider Details

I. General information

NPI: 1710949961
Provider Name (Legal Business Name): CRAIG BRADFORD LANGMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 04/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE MAIL STOP #37
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE MAIL STOP #37
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6555
  • Fax: 312-227-9406
Mailing address:
  • Phone: 312-227-6555
  • Fax: 312-227-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number036063022
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: