Basic Information
Provider Information | |||||||||
NPI: | 1063496818 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LANGNAS | ||||||||
FirstName: | GARY | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 27483 DEQUINDRE RD | ||||||||
Address2: | SUITE 302 | ||||||||
City: | MADISON HEIGHTS | ||||||||
State: | MI | ||||||||
PostalCode: | 480713491 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2485476603 | ||||||||
FaxNumber: | 2485475696 | ||||||||
Practice Location | |||||||||
Address1: | 27483 DEQUINDRE RD | ||||||||
Address2: | SUITE 302 | ||||||||
City: | MADISON HEIGHTS | ||||||||
State: | MI | ||||||||
PostalCode: | 480713491 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2485476603 | ||||||||
FaxNumber: | 2485475696 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/05/2005 | ||||||||
LastUpdateDate: | 02/16/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101009201 | MI | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 1063496818 | 05 | MI |   | MEDICAID | 120346 | 01 | MI | CARE-PREFERRED CHOICES | OTHER | 5632708 | 01 | MI | BCBS INDIVIDUAL | OTHER | 11017093 | 01 | MI | RR MEDICARE | OTHER | 700H217350 | 01 | MI | BLUE SHIELD | OTHER | F01946 | 01 | MI | HAP | OTHER |