Provider Demographics
NPI:1356320063
Name:LANG, NICOLE LISA (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LISA
Last Name:LANG
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 1:2843 S BAYSHORE DR
Mailing Address - Street 2:APT 6A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6015
Mailing Address - Country:US
Mailing Address - Phone:305-443-0030
Mailing Address - Fax:
Practice Address - Street 1:5000 UNIVERSITY DR
Practice Address - Street 2:ER DEPARTMENT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-2008
Practice Address - Country:US
Practice Address - Phone:786-308-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007831207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258589800Medicaid
FL49822OtherBCBS
FLH08892Medicare UPIN
FL49822MMedicare ID - Type Unspecified