Individual
DANIEL LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 N 1ST ST, SPRINGFIELD, IL 62702-3778
(172) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2499
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036106192
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340020547
RAILROAD
IL
01
—
IL2613
MEDICARE GROUP PTAN
IL
Enumeration date
07/19/2006
Last updated
11/29/2021
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