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General NPI Number Information
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NPI Number | 1497857122
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Entity Type | Individual
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Provider Name | KENNETH C LANE MD
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2500 METROHEALTH DR MHMC-MEDICINE/HEMATOLOGY-ONCOLOGY
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City | CLEVELAND
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State | OH
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Zip | 44109-1900
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Country | US
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Telephone | 216-778-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 METROHEALTH DR MHMC-MEDICINE/HEMATOLOGY-ONCOLOGY
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City | CLEVELAND
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State | OH
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Zip | 44109-1900
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Country | US
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Telephone | 216-778-8349
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 35044512
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License Number State | OH
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