Provider Demographics
NPI:1962677450
Name:S DAVID LANG MD LIMITED
Entity Type:Organization
Organization Name:S DAVID LANG MD LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOREN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-933-2221
Mailing Address - Street 1:400 N WALL ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2963
Mailing Address - Country:US
Mailing Address - Phone:815-933-2221
Mailing Address - Fax:815-933-7363
Practice Address - Street 1:400 N WALL ST
Practice Address - Street 2:STE 410
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2963
Practice Address - Country:US
Practice Address - Phone:815-933-2221
Practice Address - Fax:815-933-7363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208781Medicare PIN