Healthcare Provider Details

I. General information

NPI: 1144892910
Provider Name (Legal Business Name): KATELYN NICOLE LANGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATELYN NICOLE KREITZBENDER

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 EAST BIG BEAVER SUITE 200
TROY MI
48083
US

IV. Provider business mailing address

215 EAST BIG BEAVER SUITE 200
TROY MI
48083
US

V. Phone/Fax

Practice location:
  • Phone: 248-362-3500
  • Fax: 248-362-1941
Mailing address:
  • Phone: 248-362-3500
  • Fax: 248-362-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010371
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601010371
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: