Mfowethu Theophilus Langeni, DO
Family Medicine in Bloomington, IL. Individual provider (NPI-1).
NPI number1164082533
StatusActive
Last updated in NPPESJul 25, 2024
Details
- NPI
- 1164082533
- Entity type
- Individual (NPI-1)
- Name
- Mfowethu Theophilus Langeni
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 18, 2019
- Certification date
- Jul 25, 2024
- Last updated
- Jul 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 036171236 | IL | Yes |
| 207Q00000X | Family Medicine | 05361 | KY |
Practice location
210 Saint Joseph DrBloomington, IL 61701-3636
Phone 309-663-5050 · Fax 309-662-3401
Mailing address
210 Saint Joseph DrBloomington, IL 61701-3636
Phone 309-663-5050 · Fax 309-662-3401
Other practice locations
4900 Houston Rd
Florence, KY 41042-4824
Florence, KY 41042-4824
Phone 859-301-8074 · Fax 859-301-4945
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