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General NPI Number Information
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NPI Number | 1891028460
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Entity Type | Organization
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Legal Business Name | PHILIP E. LANE MD, SC
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 2947 W BONNIE BROOK LN
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City | WAUKEGAN
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State | IL
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Zip | 60087-2838
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Country | US
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Telephone | 847-662-8009
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Fax | 847-662-5513
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Provider Business Mailing Address
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Address Line | 21707 W OLD BARN LN
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City | LAKE ZURICH
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State | IL
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Zip | 60047-1612
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Country | US
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Telephone | 847-438-5447
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Fax | 847-438-9337
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP EDWARD LANE
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Credential | MD
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Telephone | 312-953-0866
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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 | 036-051264
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036-030074
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License Number State | IL
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