Healthcare Provider Details

I. General information

NPI: 1710959416
Provider Name (Legal Business Name): KATHLEEN M LANGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13825 S REDWOOD RD STE 200
BLUFFDALE UT
84065-5255
US

IV. Provider business mailing address

13825 S REDWOOD RD STE 200
BLUFFDALE UT
84065-5255
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-2626
  • Fax: 801-569-5333
Mailing address:
  • Phone: 801-569-2626
  • Fax: 801-569-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number13263241205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: