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NPI Code Detail

MEDICARE: HEIDI K. LANG D.O.

MEDICARE: HEIDI K. LANG D.O.
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
1207R00000XInternal Medicine Physician02002486AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1110238088OTHERRAILROAD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000221102OTHERINANTHEM
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699741561
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI K. LANG D.O.
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2231 CAREW ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-4713
Country : US
Telephone Number : 260-373-7765
Fax Number : 260-373-7760
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 10/13/2023

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Directions to “ HEIDI K. LANG D.O.” Practice Location

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