MEDICARE: DR. ASHLEY MICHELE LANE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	5101019403	MI

General Provider Information

NPI Number	:	1023306388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY MICHELE LANE D.O.

Provider Business Mailing Address
First Line	:	1195 N OAKLAND AVE
Second Line	:
City	:	BOLIVAR
State	:	MO
Zip	:	65613-8095
Country	:	US
Telephone Number	:	417-777-8131
Fax Number	:	417-777-8892

Provider Business Practice Location Address
First Line	:	1195 N OAKLAND AVE
Second Line	:
City	:	BOLIVAR
State	:	MO
Zip	:	65613-8095
Country	:	US
Telephone Number	:	417-777-8131
Fax Number	:	417-777-8892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	09/11/2015

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