Provider Demographics
NPI:1225224397
Name:LANG, LINDA LEAH (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEAH
Last Name:LANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 N HOWE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5125
Mailing Address - Country:US
Mailing Address - Phone:312-915-0222
Mailing Address - Fax:
Practice Address - Street 1:921 N PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4761
Practice Address - Country:US
Practice Address - Phone:847-359-3400
Practice Address - Fax:847-348-3402
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-000727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085-000727OtherLICENSE