Provider Demographics
NPI:1598928376
Name:LANGE, EMILY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MARIE
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:STE 312
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-396-7880
Practice Address - Fax:712-396-7885
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5861207V00000X
IA41994207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026211300Medicaid
IA1598928376Medicaid
NE47068731777Medicaid
NE47068731777Medicaid
IA075120021Medicare PIN