Healthcare Provider Details

I. General information

NPI: 1548244304
Provider Name (Legal Business Name): WALTER C. LANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36123 SCHOOLCRAFT RD
LIVONIA MI
48150-1216
US

IV. Provider business mailing address

36123 SCHOOLCRAFT RD
LIVONIA MI
48150-1216
US

V. Phone/Fax

Practice location:
  • Phone: 734-793-6140
  • Fax: 734-402-0254
Mailing address:
  • Phone: 734-793-6140
  • Fax: 734-402-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101010757
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: