MEDICARE: MICHAEL W. LANE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	44281	TN
2	208100000X	Physical Medicine & Rehabilitation Physician	01066599A	IN
3	208100000X	Physical Medicine & Rehabilitation Physician	0101235883	VA

General Provider Information

NPI Number	:	1073573465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL W. LANE M.D.

Provider Business Mailing Address
First Line	:	1515 N STATE ST
Second Line	:
City	:	GREENFIELD
State	:	IN
Zip	:	46140
Country	:	US
Telephone Number	:	317-467-4300
Fax Number	:	317-467-4302

Provider Business Practice Location Address
First Line	:	5035 W. 71ST ST., STE E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228
Country	:	US
Telephone Number	:	317-291-0100
Fax Number	:	317-291-2501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	11/05/2010

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