Provider Demographics
NPI:1699483099
Name:LANG, MISTY D (MD)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:D
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 19638
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9638
Mailing Address - Country:US
Mailing Address - Phone:217-545-4401
Mailing Address - Fax:217-545-1793
Practice Address - Street 1:701 N 1ST ST STE D308
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3757
Practice Address - Country:US
Practice Address - Phone:217-545-4401
Practice Address - Fax:217-545-1793
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL125.082443208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery