Provider Demographics
NPI:1710949961
Name:LANGMAN, CRAIG BRADFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:BRADFORD
Last Name:LANGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:MAIL STOP #37
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6555
Mailing Address - Fax:312-227-9406
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:MAIL STOP #37
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6555
Practice Address - Fax:312-227-9406
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360630222080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063022Medicaid
IL036063022Medicaid