Provider Demographics
NPI:1528160728
Name:LANG, STEPHEN GLOVER (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GLOVER
Last Name:LANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:555 WEST WACKERLY STREET
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4713
Mailing Address - Country:US
Mailing Address - Phone:989-839-1234
Mailing Address - Fax:989-839-7090
Practice Address - Street 1:555 WEST WACKERLY STREET
Practice Address - Street 2:SUITE 3500
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4713
Practice Address - Country:US
Practice Address - Phone:989-839-1234
Practice Address - Fax:989-839-7090
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301401783207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0705600882OtherBLUECROSSBLUESHIELD
G36801OtherCONNECTCAREAETNA PPO DOW
0705600882OtherBLUECROSSBLUESHIELD
G36801OtherCONNECTCAREAETNA PPO DOW