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NPI Code Detail

MEDICARE: KRISTIN RENEE LANGE PA

MEDICARE:   KRISTIN RENEE 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
1363AS0400XSurgical Physician Assistant085001706IL

General Provider Information

NPI Number : 1568437010
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN RENEE LANGE PA
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 880 WEST CENTRAL ROAD
Second Line : SUITE 3800
City : ARLINGTON HEIGHTS
State : IL
Zip : 60005-2369
Country : US
Telephone Number : 847-483-9800
Fax Number : 847-483-9808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 12/03/2020

Similar Medicare Providers

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Directions to “ KRISTIN RENEE LANGE PA” Practice Location

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