Healthcare Provider Details

I. General information

NPI: 1790205375
Provider Name (Legal Business Name): STEPHANIE KATE LANGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 TELEGRAPH RD
TAYLOR MI
48180
US

IV. Provider business mailing address

555 E TACHEVAH DR STE 2E107
PALM SPRINGS CA
92262-5752
US

V. Phone/Fax

Practice location:
  • Phone: 949-677-4638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301113304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: