Provider Demographics
NPI:1699703595
Name:LANGHEINRICH, WALTER S (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:S
Last Name:LANGHEINRICH
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 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:100 NAVARRE PL
Practice Address - Street 2:SUITE 6600
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1156
Practice Address - Country:US
Practice Address - Phone:574-232-7227
Practice Address - Fax:574-232-2064
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042688A207T00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100410110Medicaid
INM400033278OtherMEDICARE PTAN
IN000000686406OtherBCBS BMG NEUROSURGERY SB
INP00933715OtherRR MEDICARE
INM400033278OtherMEDICARE PTAN
INM400033278Medicare PIN