Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101008789 | MI |
NPI | 1194772681 |
---|---|
Provider Name | Dr. Paula Lange |
First Address | Carmel, IN 46032-8733 |
Second Address | Carmel, IN 46032-8733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 17/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000494149 | ANTHEM (01) | IN |
114703958 | (05) | MI |
200836700 | (05) | IN |
F13992 | (02) | MI |
PL008789 | BC/BS OF MICHIGAN (01) | MI |