Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 125.068739 | IL |
Y | 2080P0201X | Pediatric Allergist | 036.148448 | IL |
NPI | 1609238575 |
---|---|
Provider Name | Abigail Theresia Lang |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 03/10/2019 |