Provider Demographics
NPI:1518950807
Name:LANG, MICHAEL VERNON (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VERNON
Last Name:LANG
Suffix:
Gender:M
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:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-7697
Mailing Address - Country:US
Mailing Address - Phone:270-745-1467
Mailing Address - Fax:270-745-1417
Practice Address - Street 1:466 BURNLEY RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-6355
Practice Address - Country:US
Practice Address - Phone:270-618-3700
Practice Address - Fax:270-618-3772
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183458OtherMEDICARE GROUP
KY183458OtherMEDICARE GROUP
0566946Medicare ID - Type Unspecified