Provider Demographics
NPI:1710071139
Name:MADLANG, RODOLFO G (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:G
Last Name:MADLANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:4401 HARRISON BOULEVARD
Practice Address - Street 2:MCKAY DEE HOSPITAL
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT82-169053-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1502954OtherUMWA
UT2090168OtherUNITED HEALTHCARE
ID804070100Medicaid
UT870545614MA1OtherEDUCATORS MUTUAL
NV100501221Medicaid
WY110961800Medicaid
UTPRA04118OtherMOLINA
UTQM0000075886OtherALTIUS
UT107005082102OtherIHC
AZ820953Medicaid
UT36507OtherDESERET MUTUAL
UT37803OtherPEHP
UT53253OtherHEALTHY U
UT8597445OtherWORKERS COMP
UT870545614MA1OtherEDUCATORS MUTUAL
UT8597445OtherWORKERS COMP
UT53253OtherHEALTHY U