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NPI Code Detail

MEDICARE: ANDREW LANGE PA

MEDICARE: ANDREW LANGE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant085-002426IL
2363A00000XPhysician Assistant1976WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194771428
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW LANGE PA
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 709 SPRING VALLEY RD
Second Line :
City : BURLINGTON
State : WI
Zip : 53105-7614
Country : US
Telephone Number : 262-767-6020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 10/02/2023

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Directions to “ ANDREW LANGE PA” Practice Location

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