Provider Demographics
NPI:1710959416
Name:LANGER, KATHLEEN M (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:LANGER
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 1:13825 S REDWOOD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-5255
Mailing Address - Country:US
Mailing Address - Phone:801-569-2626
Mailing Address - Fax:801-569-5333
Practice Address - Street 1:13825 S REDWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5255
Practice Address - Country:US
Practice Address - Phone:801-569-2626
Practice Address - Fax:801-569-5333
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13263241205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT343640302009Medicaid
UT005514802Medicare ID - Type Unspecified
UT343640302009Medicaid