Healthcare Provider Details

I. General information

NPI: 1962677450
Provider Name (Legal Business Name): S DAVID LANG MD LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WALL ST STE 410
KANKAKEE IL
60901-2963
US

IV. Provider business mailing address

400 N WALL ST SUITE 410
KANKAKEE IL
60901-2963
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-2221
  • Fax: 815-933-7363
Mailing address:
  • Phone: 815-933-2221
  • Fax: 815-933-7363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SOREN DAVID LANG
Title or Position: PRESIDENT
Credential: MD
Phone: 815-933-2221