Provider Demographics
NPI:1992719025
Name:LANG, RITA M (DO)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:M
Last Name:LANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-0628
Mailing Address - Country:US
Mailing Address - Phone:810-664-8541
Mailing Address - Fax:810-664-0333
Practice Address - Street 1:396 LAKE NEPESSING RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2996
Practice Address - Country:US
Practice Address - Phone:810-664-8541
Practice Address - Fax:810-664-0333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI008330208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2683800Medicaid
MI0154400444OtherBLUE CROSS
MI0154400444OtherBLUE CROSS
MI5440044Medicare ID - Type Unspecified