Healthcare Provider Details

I. General information

NPI: 1093715450
Provider Name (Legal Business Name): SCOTT E. LANGENBURG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22151 MOROSS RD STE 209
DETROIT MI
48236
US

IV. Provider business mailing address

22151 MOROSS RD STE 209
DETROIT MI
48236-2177
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-3978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number4301069906
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: