Provider Demographics
NPI:1538263256
Name:LANG, SOREN DAVID (M D)
Entity type:Individual
Prefix:DR
First Name:SOREN
Middle Name:DAVID
Last Name:LANG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N. WALL ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2963
Mailing Address - Country:US
Mailing Address - Phone:815-933-2221
Mailing Address - Fax:815-933-7363
Practice Address - Street 1:400 N. WALL ST
Practice Address - Street 2:SUITE 410
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2963
Practice Address - Country:US
Practice Address - Phone:815-933-2221
Practice Address - Fax:815-933-7363
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360573232086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057323Medicaid
IL208781Medicare ID - Type Unspecified
IL036057323Medicaid