Provider Demographics
NPI:1699751479
Name:LANGE, ANN M (DPM)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:LANGE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6661 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1011
Mailing Address - Country:US
Mailing Address - Phone:608-829-2535
Mailing Address - Fax:608-829-1319
Practice Address - Street 1:6661 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1011
Practice Address - Country:US
Practice Address - Phone:608-829-2535
Practice Address - Fax:608-829-1319
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI745213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI85630Medicare ID - Type Unspecified
WIU88951Medicare UPIN