Provider Demographics
NPI:1497753156
Name:LANGE, CASSANDRA SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:SUZANNE
Last Name:LANGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 1ST AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5330
Mailing Address - Country:US
Mailing Address - Phone:319-449-4763
Mailing Address - Fax:
Practice Address - Street 1:1962 1ST AVE NE STE A
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5330
Practice Address - Country:US
Practice Address - Phone:319-449-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34157207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38135OtherBLUE CROSS/BLUE SHIELD
IA1234757Medicaid
IA1234757Medicaid
IAG18294Medicare UPIN