Healthcare Provider Details

I. General information

NPI: 1841410941
Provider Name (Legal Business Name): WILLIAM F LANGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 E PARKDALE AVE
MANISTEE MI
49660-9709
US

IV. Provider business mailing address

10850 E TRAVERSE HWY SUITE 4400
TRAVERSE CITY MI
49684-1364
US

V. Phone/Fax

Practice location:
  • Phone: 231-398-1000
  • Fax: 989-340-1214
Mailing address:
  • Phone: 231-346-6800
  • Fax: 989-340-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5412
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: