Healthcare Provider Details

I. General information

NPI: 1134128549
Provider Name (Legal Business Name): ANETTE C. LANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 E US HIGHWAY 36 STE 1320
AVON IN
46123-9688
US

IV. Provider business mailing address

6300 SOUTHEASTERN AVE
INDIANAPOLIS IN
46203-5828
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-7519
  • Fax: 317-272-3661
Mailing address:
  • Phone: 317-803-2515
  • Fax: 317-803-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01054524A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: