Provider Demographics
NPI:1568506988
Name:TANGEN, LORRAINE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MARIE
Last Name:TANGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:TANGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:AMG -ESTHERVILLE 926 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334
Mailing Address - Country:US
Mailing Address - Phone:712-362-6501
Mailing Address - Fax:712-362-7190
Practice Address - Street 1:AMG -ESTHERVILLE 926 N 8TH ST
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334
Practice Address - Country:US
Practice Address - Phone:712-362-6501
Practice Address - Fax:712-362-7190
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-50220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010002487OtherBLUE SHIELD OF IDAHO
IDDP070OtherBLUE CROSS OF IDAHO
ID003978700Medicaid
ID820227163G0020OtherTRICARE
ID1129286OtherSTATE INSURANCE FUND
IDF66063Medicare UPIN
IDDP070OtherBLUE CROSS OF IDAHO