Provider Demographics
NPI:1497078604
Name:BECKY A LANG M.D. PLLC
Entity Type:Organization
Organization Name:BECKY A LANG M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-891-9900
Mailing Address - Street 1:601 MULHOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-4208
Mailing Address - Country:US
Mailing Address - Phone:989-891-9900
Mailing Address - Fax:989-891-9909
Practice Address - Street 1:601 MULHOLLAND ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-4208
Practice Address - Country:US
Practice Address - Phone:989-891-9900
Practice Address - Fax:989-891-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBL076034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G36028021Medicare PIN
MI106821Medicare UPIN