Provider Demographics
NPI:1306931852
Name:LANGENKAMP, PAUL HENRY (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HENRY
Last Name:LANGENKAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 RUBY LN
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1082
Mailing Address - Country:US
Mailing Address - Phone:419-678-8397
Mailing Address - Fax:
Practice Address - Street 1:1104 RUBY LN
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1082
Practice Address - Country:US
Practice Address - Phone:419-678-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056214207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000212245OtherANTHEM
OH2291694Medicaid
A17455Medicare UPIN