Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 41495 | MN |
NPI | 1013992684 |
---|---|
Provider Name | Dr. Alison M Lang |
First Address | St Louis Park, MN 55426-1728 |
Second Address | St Louis Park, MN 55416-2527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 10/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H05926 | (02) |