Provider Demographics
NPI:1093715450
Name:LANGENBURG, SCOTT E (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:LANGENBURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HUGHES DR
Mailing Address - Street 2:SUITE 620
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3845
Mailing Address - Country:US
Mailing Address - Phone:419-291-2126
Mailing Address - Fax:419-291-6967
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:SUITE 620
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2126
Practice Address - Fax:419-291-6967
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010699062086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000521515OtherANTHEM
OH04561OtherPARAMOUNT
MI4672412Medicaid
OH7633064OtherAETNA
MI4115606Medicaid
MI5202232Medicaid
MI4072053Medicaid
7660OtherHEALTH PLAN OF MI
SL069906OtherCOMMERCIAL-COMMERCIAL NUMBER
OH2486804OtherBCMH
OH2486804Medicaid
146595OtherGLHP
MI4072053Medicaid
OH2486804Medicaid