Individual
BROOKE A LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
830 W HIGH ST STE 360, LIMA, OH 45801-3985
(419) 227-7117
(419) 227-2848
Mailing address
PO BOX 636930, CINCINNATI, OH 45263-6930
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50.004109
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105065
MEDICAID GROUP
OH
05
—
0116351
—
OH
01
—
1184652539
GROUP NPI
OH
01
—
9943723
MEDICARE GROUP PTAN
OH
Enumeration date
12/29/2014
Last updated
04/01/2020
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