Individual
MFOWETHU THEOPHILUS LANGENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
210 SAINT JOSEPH DR, BLOOMINGTON, IL 61701-3636
(309) 663-5050
(309) 662-3401
Mailing address
210 SAINT JOSEPH DR, BLOOMINGTON, IL 61701-3636
(309) 663-5050
(309) 662-3401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036171236
IL
207Q00000X
Family Medicine Physician
05361
KY
Other
Enumeration date
06/18/2019
Last updated
07/25/2024
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