Healthcare Provider Details

I. General information

NPI: 1841382371
Provider Name (Legal Business Name): PATRICIA L LANGEHENNIG MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 N CHICAGO ST
JOLIET IL
60432-4315
US

IV. Provider business mailing address

2420 GLENWOOD AVE
JOLIET IL
60435-4315
US

V. Phone/Fax

Practice location:
  • Phone: 815-722-7000
  • Fax: 815-722-7180
Mailing address:
  • Phone: 815-722-7000
  • Fax: 815-722-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036053311
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036053311
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: