Provider Demographics
NPI:1083672620
Name:LANG, VINCENT JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:LANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:12010 SHELBYVILLE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1054
Practice Address - Country:US
Practice Address - Phone:502-897-9191
Practice Address - Fax:502-897-9191
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060702207Q00000X
KYTP073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200506660Medicaid
INF27809Medicare UPIN
IN090540YMedicare PIN