Provider Demographics
NPI:1851593024
Name:LANG, KELLEY MAREE (MD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:MAREE
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2633 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0585
Mailing Address - Country:US
Mailing Address - Phone:850-431-5404
Mailing Address - Fax:850-431-4794
Practice Address - Street 1:2633 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0585
Practice Address - Country:US
Practice Address - Phone:850-431-5404
Practice Address - Fax:850-431-4794
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2018-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME104789207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001212100Medicaid
FL146KJOtherBLUE CROSS BLUE SHIELD
FL001212100Medicaid