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Individual

ANDREW LANGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
709 SPRING VALLEY RD, BURLINGTON, WI 53105-7614
(262) 767-6020
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-002426
IL
363A00000X
Physician Assistant
Primary
1976
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
42892000
WI
Enumeration date
05/26/2006
Last updated
10/02/2023
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