Mfowethu Theophilus Langeni, DO | |
210 Saint Joseph Dr, Bloomington, IL 61701-3636 | |
(309) 663-5050 | |
(309) 662-3401 |
Full Name | Mfowethu Theophilus Langeni |
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Gender | Male |
Speciality | Family Medicine |
Location | 210 Saint Joseph Dr, Bloomington, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1164082533 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 05361 (Kentucky) | Secondary |
207Q00000X | Family Medicine | 036171236 (Illinois) | Primary |
Entity Name | Summit Medical Group, Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1508287640 PECOS PAC ID: 2163326240 Enrollment ID: O20031120000738 |
Mailing Address | Practice Location Address |
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Mfowethu Theophilus Langeni, DO 210 Saint Joseph Dr, Bloomington, IL 61701-3636 Ph: (309) 663-5050 | Mfowethu Theophilus Langeni, DO 210 Saint Joseph Dr, Bloomington, IL 61701-3636 Ph: (309) 663-5050 |
Dr. Justin James Holschbach, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 308 Saint Joseph Dr, Bloomington, IL 61701 Phone: 309-663-5050 Fax: 309-662-3401 | |
Jermy Enrique Crespo Gonzalez, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 2200 East Washington Street, Bloomington, IL 61701 Phone: 309-665-5996 | |
Stephen Belgrave, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 1701 E College Ave, Bloomington, IL 61704 Phone: 309-664-3170 | |
Daniel Marley, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1701 E College Ave, Bloomington, IL 61704 Phone: 309-664-3170 | |
Shilpa Mehta, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1505 Eastland Dr, Bloomington, IL 61701 Phone: 309-663-2100 Fax: 309-663-8322 | |
Kenneth Wayne Birge Jr., MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2502 E Empire St, Bloomington, IL 61704 Phone: 309-300-1031 |