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General NPI Number Information
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NPI Number | 1457555229
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Entity Type | Organization
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Legal Business Name | DML MOBILE ANESTHESIA , LLC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 321 E WAYNE ST
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City | FORT WAYNE
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State | IN
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Zip | 46802-2713
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Country | US
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Telephone | 260-424-5656
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Fax |
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Provider Business Mailing Address
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Address Line | 524 N RILEY RD
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City | MUNCIE
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State | IN
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Zip | 47304-3852
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Country | US
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Telephone | 765-284-1590
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD M. LANE
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Credential | M.D.
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Telephone | 765-622-8137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01030689A
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License Number State | IN
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