Provider Demographics
NPI:1245448505
Name:LANG, GORDON EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:EDWARD
Last Name:LANG
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 1:5124 N ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5743
Mailing Address - Country:US
Mailing Address - Phone:414-963-9951
Mailing Address - Fax:414-963-9861
Practice Address - Street 1:5124 N ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-5743
Practice Address - Country:US
Practice Address - Phone:414-963-9951
Practice Address - Fax:414-963-9861
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13754-020207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB54429Medicare UPIN