Provider Demographics
NPI:1285627489
Name:LANG, TIMOTHY G (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:G
Last Name:LANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:STE 330
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-576-7013
Mailing Address - Fax:314-576-4047
Practice Address - Street 1:224 S WOODS MILL RD STE 330S
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3497
Practice Address - Country:US
Practice Address - Phone:314-576-7013
Practice Address - Fax:314-576-4047
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO200017290207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
10852601OtherCAQH
144067OtherBLUE CROSS BLUE SHIELD
005010584Medicare ID - Type Unspecified
10852601OtherCAQH
0355550001Medicare NSC