Provider Demographics
NPI:1164082533
Name:LANGENI, MFOWETHU THEOPHILUS (DO)
Entity type:Individual
Prefix:
First Name:MFOWETHU
Middle Name:THEOPHILUS
Last Name:LANGENI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SAINT JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3636
Mailing Address - Country:US
Mailing Address - Phone:309-663-5050
Mailing Address - Fax:309-662-3401
Practice Address - Street 1:210 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3636
Practice Address - Country:US
Practice Address - Phone:309-663-5050
Practice Address - Fax:309-662-3401
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05361207Q00000X
IL036171236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine