Provider Demographics
NPI:1295782571
Name:LANG CARNEY, MARY IRENE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:IRENE
Last Name:LANG CARNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:LANG
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:SUITE 166 EAST TOWER
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-316-8700
Mailing Address - Fax:847-316-8702
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:SUITE 166 EAST TOWER
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-316-8700
Practice Address - Fax:847-316-8702
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-055043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD14258Medicare UPIN