Individual
DR. NICHOLAS LANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2355 HIGHWAY 36 W STE 100, ROSEVILLE, MN 55113-3905
(651) 292-0000
Mailing address
2355 HIGHWAY 36 W STE 100, ROSEVILLE, MN 55113-3905
(651) 292-0000
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
0101239993
VA
2085R0202X
Diagnostic Radiology Physician
Primary
65880
MN
Other
Enumeration date
07/14/2006
Last updated
07/19/2021
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