Provider Demographics
NPI:1821318049
Name:LANG, JEANA MANAAY (MD)
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:MANAAY
Last Name:LANG
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 1:1255 W EDDY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1485
Mailing Address - Country:US
Mailing Address - Phone:773-528-6552
Mailing Address - Fax:
Practice Address - Street 1:6501 N LINCOLN AVE
Practice Address - Street 2:LINCOLNWOOD MEDICAL CENTER
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3925
Practice Address - Country:US
Practice Address - Phone:847-242-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036132639208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics