Provider Demographics
NPI:1811998909
Name:LANG, CAROL LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:LANG
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Gender:F
Credentials:DO
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Mailing Address - Street 1:300 S BRUCE ST
Mailing Address - Street 2:AVERA MARSHALL
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1934
Mailing Address - Country:US
Mailing Address - Phone:507-537-9007
Mailing Address - Fax:507-537-2720
Practice Address - Street 1:300 S BRUCE ST
Practice Address - Street 2:AVERA MARSHALL
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1934
Practice Address - Country:US
Practice Address - Phone:507-537-9007
Practice Address - Fax:507-537-2720
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2015-03-09
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Provider Licenses
StateLicense IDTaxonomies
MN40297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6412203-00Medicaid
MNH400091813Medicare PIN
MN6412203-00Medicaid