MEDICARE: EDWIN L DELANGE, DO PC

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	261QP2300X	Primary Care Clinic/Center	5101008382	MI

General Provider Information

NPI Number	:	1821394297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWIN L DELANGE, DO PC

Provider Business Mailing Address
First Line	:	3273 DAVISON RD
Second Line	:	SUITE #2
City	:	LAPEER
State	:	MI
Zip	:	48446-2902
Country	:	US
Telephone Number	:	810-667-8840
Fax Number	:

Provider Business Practice Location Address
First Line	:	3273 DAVISON RD
Second Line	:	SUITE #2
City	:	LAPEER
State	:	MI
Zip	:	48446-2902
Country	:	US
Telephone Number	:	810-667-8840
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. EDWIN LEE DELANGE DO PC
Credential	:	D.O.
Telephone Number	:	810-667-8840

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	04/18/2011

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