Provider Demographics
NPI:1083621940
Name:LANGE, BARBARA LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LYNN
Last Name:LANGE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14810 SOUTH CICERO AVENUE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1400
Mailing Address - Country:US
Mailing Address - Phone:708-560-3676
Mailing Address - Fax:708-535-3091
Practice Address - Street 1:14810 SOUTH CICERO AVENUE
Practice Address - Street 2:SUITE 1D
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1400
Practice Address - Country:US
Practice Address - Phone:708-560-3676
Practice Address - Fax:708-535-3091
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005079213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist