MEDICARE: DR. PATRICIA L LANGEHENNIG MD, MPH

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	207R00000X	Internal Medicine Physician	036053311	IL
2	208000000X	Pediatrics Physician	036053311	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	09932150	OTHER	IL	BLUE CROSS / BLUE SHIELD

General Provider Information

NPI Number	:	1841382371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA L LANGEHENNIG MD, MPH

Provider Business Mailing Address
First Line	:	2420 GLENWOOD AVE
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-4315
Country	:	US
Telephone Number	:	815-722-7000
Fax Number	:	815-722-7180

Provider Business Practice Location Address
First Line	:	72 N CHICAGO ST
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60432-4315
Country	:	US
Telephone Number	:	815-722-7000
Fax Number	:	815-722-7180

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	04/24/2014

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