Provider Demographics
NPI:1821394297
Name:EDWIN L DELANGE, DO PC
Entity Type:Organization
Organization Name:EDWIN L DELANGE, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DELANGE DO PC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-667-8840
Mailing Address - Street 1:3273 DAVISON RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2902
Mailing Address - Country:US
Mailing Address - Phone:810-667-8840
Mailing Address - Fax:
Practice Address - Street 1:3273 DAVISON RD
Practice Address - Street 2:SUITE #2
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2902
Practice Address - Country:US
Practice Address - Phone:810-667-8840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008382261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION50690Medicare PIN