Healthcare Provider Details

I. General information

NPI: 1073573465
Provider Name (Legal Business Name): MICHAEL W. LANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 W. 71ST ST., STE E
INDIANAPOLIS IN
46228
US

IV. Provider business mailing address

1515 N STATE ST
GREENFIELD IN
46140
US

V. Phone/Fax

Practice location:
  • Phone: 317-291-0100
  • Fax: 317-291-2501
Mailing address:
  • Phone: 317-467-4300
  • Fax: 317-467-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number44281
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number01066599A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101235883
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: