Provider Demographics
NPI:1326583238
Name:LANG, DOREEN
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:
Other - Last Name:PALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52884 SEVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-2988
Mailing Address - Country:US
Mailing Address - Phone:248-953-8419
Mailing Address - Fax:
Practice Address - Street 1:2384 E WALTON BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326
Practice Address - Country:US
Practice Address - Phone:248-475-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-31
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor