Healthcare Provider Details

I. General information

NPI: 1932141157
Provider Name (Legal Business Name): DAVID A LANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W SAINT GEORGE AVE
GRANTSBURG WI
54840
US

IV. Provider business mailing address

257 W SAINT GEORGE AVE
GRANTSBURG WI
54840-7827
US

V. Phone/Fax

Practice location:
  • Phone: 715-463-5353
  • Fax:
Mailing address:
  • Phone: 715-463-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26727
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61281
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: