Provider Demographics
NPI:1245212117
Name:LANG CORREA, KARL MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:MICHAEL
Last Name:LANG CORREA
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 1084
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1084
Mailing Address - Country:US
Mailing Address - Phone:787-884-5100
Mailing Address - Fax:787-807-2298
Practice Address - Street 1:CARR # 2 KM 40.1 BARRIO ALGARROBO
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-807-2297
Practice Address - Fax:787-884-0688
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE32730Medicare UPIN
PR29024Medicare ID - Type Unspecified