1578569810 NPI number — ELLIOT N LANG MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578569810 NPI number — ELLIOT N LANG MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LANG

Provider First Name:

ELLIOT

Provider Middle Name:

N

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1578569810

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/06/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

11767 S DIXIE HWY

Provider Second Line Business Mailing Address:

SUITE 357

Provider Business Mailing Address City Name:

MIAMI

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33156-4438

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

786-342-8082

Provider Business Mailing Address Fax Number:

800-404-0732

Provider First Line Business Practice Location Address:

14201 S DIXIE HWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MIAMI

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33176-7224

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

786-342-8082

Provider Business Practice Location Address Fax Number:

800-404-0732

Provider Enumeration Date:

06/22/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  ME36255 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1578569810 . This is a "MD MEDICARE CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 200010269 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 13452 . This is a "ALL FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 160502400 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
• Identifier: 52550 . This is a "JMH" identifier . This identifiers is of the category "OTHER".
• Identifier: 1003510 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
• Identifier: 12257 . This is a "WELL CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 250451100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 592417574001 . This is a "CHAMPUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 7574 . This is a "AV MED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 95490 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 273481 . This is a "ONE HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 9314 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".