Provider Demographics
NPI:1790730760
Name:LANGELAND, FRITJOF FLUGE (MD)
Entity Type:Individual
Prefix:DR
First Name:FRITJOF
Middle Name:FLUGE
Last Name:LANGELAND
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-5155
Mailing Address - Fax:801-408-5156
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:STE 178
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-5155
Practice Address - Fax:801-408-5156
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT160880-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D87769Medicare UPIN
UT000063370Medicare PIN