MEDICARE: DR. DAVID PAUL LANG MD

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
1	208D00000X	General Practice Physician	036.128396	IL
2	207V00000X	Obstetrics & Gynecology Physician	MD-43441	IA

General Provider Information

NPI Number	:	1619167194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PAUL LANG MD

Provider Business Mailing Address
First Line	:	2003 W FULTON ST # 303
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2345
Country	:	US
Telephone Number	:	312-243-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 W FULTON ST # 303
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2345
Country	:	US
Telephone Number	:	312-243-2223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	03/03/2020

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