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NPI Code Detail

MEDICARE: DANIEL LANGE M.D.

MEDICARE: DANIEL LANGE M.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
1208800000XUrology Physician036106192IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2IL2613OTHERILMEDICARE GROUP PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1340020547OTHERILRAILROAD

General Provider Information

NPI Number : 1972522720
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL LANGE M.D.
Provider Business Mailing Address
First Line : 1025 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-2499
Country : US
Telephone Number : 217-528-7541
Fax Number :
Provider Business Practice Location Address
First Line : 800 N 1ST ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62702-3778
Country : US
Telephone Number : 172-528-7541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 11/29/2021

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