Provider Demographics
NPI:1164760096
Name:NAHRWOLD, DAVID LANGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LANGE
Last Name:NAHRWOLD
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 1:2052 CLARIDGE CT
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-8613
Mailing Address - Country:US
Mailing Address - Phone:847-714-1143
Mailing Address - Fax:
Practice Address - Street 1:2052 CLARIDGE CT
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-8613
Practice Address - Country:US
Practice Address - Phone:847-714-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.064701208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery