MEDICARE: DR. BRANDON COLE 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	390200000X	Student in an Organized Health Care Education/Training Program	11017247A	IN
2	207T00000X	Neurological Surgery Physician	01084142A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851730782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON COLE LANE M.D.

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 W 10TH ST STE 6200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3082
Country	:	US
Telephone Number	:	317-274-8157
Fax Number	:

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

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	05/06/2022

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