Provider Demographics
NPI:1568437010
Name:LANGE, KRISTIN RENEE (PA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RENEE
Last Name:LANGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:880 WEST CENTRAL ROAD
Practice Address - Street 2:SUITE 3800
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2369
Practice Address - Country:US
Practice Address - Phone:847-483-9800
Practice Address - Fax:847-483-9808
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001706363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP44135Medicare UPIN