Provider Demographics
NPI:1205835782
Name:LANG, BECKY A (MD)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:A
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:A
Other - Last Name:KARBOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 MULHOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-4208
Mailing Address - Country:US
Mailing Address - Phone:989-891-9900
Mailing Address - Fax:989-891-9909
Practice Address - Street 1:601 MULHOLLAND ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-4208
Practice Address - Country:US
Practice Address - Phone:989-891-9900
Practice Address - Fax:989-891-9909
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBK076034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4589924Medicaid
MI4589924Medicaid
MI0G36028Medicare PIN