Provider Demographics
NPI:1194772681
Name:LANGE, PAULA (DO)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 TANTARA BND
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8733
Mailing Address - Country:US
Mailing Address - Phone:317-733-8252
Mailing Address - Fax:
Practice Address - Street 1:3252 TANTARA BND
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8733
Practice Address - Country:US
Practice Address - Phone:317-733-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008789207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114703958Medicaid
IN000000494149OtherANTHEM
IN200836700Medicaid
MIPL008789OtherBC/BS OF MICHIGAN
INP00415736Medicare PIN
IN809640CCCMedicare PIN
MIF13992Medicare UPIN
IN000000494149OtherANTHEM