Provider Demographics
NPI:1265499198
Name:LANGLOIS, LYNNE D (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:D
Last Name:LANGLOIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-0002
Mailing Address - Country:US
Mailing Address - Phone:262-797-8600
Mailing Address - Fax:262-797-9122
Practice Address - Street 1:2114 W COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5645
Practice Address - Country:US
Practice Address - Phone:414-324-8287
Practice Address - Fax:262-797-9122
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30017400Medicaid
WI80099Medicare ID - Type Unspecified
WIB54440Medicare UPIN