Provider Demographics
NPI:1780625210
Name:LANG, MICHAEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:LANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:901 E WILLETTA ST
Mailing Address - Street 2:STE 2503
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2727
Mailing Address - Country:US
Mailing Address - Phone:602-839-2307
Mailing Address - Fax:602-839-2307
Practice Address - Street 1:901 E WILLETTA ST
Practice Address - Street 2:STE 2503
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2727
Practice Address - Country:US
Practice Address - Phone:602-839-2307
Practice Address - Fax:602-839-2307
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-270752080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100290540BMedicaid
KS100290540BMedicaid