Healthcare Provider Details

I. General information

NPI: 1245212117
Provider Name (Legal Business Name): KARL MICHAEL LANG CORREA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR # 2 KM 40.1 BARRIO ALGARROBO
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PO BOX 1084
MANATI PR
00674-1084
US

V. Phone/Fax

Practice location:
  • Phone: 787-807-2297
  • Fax: 787-884-0688
Mailing address:
  • Phone: 787-884-5100
  • Fax: 787-807-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8482
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: