MEDICARE: KATHERINE MICHELLE LANG AU. D

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	231H00000X	Audiologist	AY1702	FL

General Provider Information

NPI Number	:	1811277288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MICHELLE LANG AU. D

Provider Business Mailing Address
First Line	:	PO BOX 41516
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-1516
Country	:	US
Telephone Number	:	904-202-5111
Fax Number	:	904-391-5836

Provider Business Practice Location Address
First Line	:	7740 POINT MEADOWS DR STE 7
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9180
Country	:	US
Telephone Number	:	904-202-6400
Fax Number	:	904-390-7383

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

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	11/04/2020

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