Healthcare Provider Details

I. General information

NPI: 1992909030
Provider Name (Legal Business Name): LANE SWAYZE CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S. MAIN ST.
ALMONT MI
48003
US

IV. Provider business mailing address

PO BOX 445 209 S. MAIN STREET
ALMONT MI
48003-0445
US

V. Phone/Fax

Practice location:
  • Phone: 810-798-3938
  • Fax: 810-798-8870
Mailing address:
  • Phone: 810-798-3938
  • Fax: 810-798-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRL004855
License Number StateMI

VIII. Authorized Official

Name: DR. ROBERT E LANE
Title or Position: OWNER
Credential: D.O.
Phone: 810-798-3938