Healthcare Provider Details

I. General information

NPI: 1457778797
Provider Name (Legal Business Name): WILLIAM LANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 11/27/2023
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8890 E 116TH ST STE 300
FISHERS IN
46038-2857
US

IV. Provider business mailing address

20000 HARVARD AVE
WARRENSVILLE HEIGHTS OH
44122-6805
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02005152A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: