Provider Demographics
NPI:1427051127
Name:LANGE, GRANT ADAM (DO)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:ADAM
Last Name:LANGE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3140
Mailing Address - Country:US
Mailing Address - Phone:586-726-5566
Mailing Address - Fax:586-726-8085
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-726-5566
Practice Address - Fax:586-726-8085
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-12-22
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Provider Licenses
StateLicense IDTaxonomies
MI5315007756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4526970Medicaid
MI4526970Medicaid