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General NPI Number Information
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NPI Number | 1821318049
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Entity Type | Individual
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Provider Name | JEANA MANAAY LANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 6501 N LINCOLN AVE LINCOLNWOOD MEDICAL CENTER
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-3925
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Country | US
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Telephone | 847-242-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 W EDDY ST APT 3
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City | CHICAGO
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State | IL
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Zip | 60657-1485
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Country | US
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Telephone | 773-528-6552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036132639
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License Number State | IL
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