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NPI Code Detail

MEDICARE: RACHAEL NICOLE LANE DO

MEDICARE:   RACHAEL NICOLE LANE  DO
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
1207Q00000XFamily Medicine Physician5151014224MI

General Provider Information

NPI Number : 1205464955
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHAEL NICOLE LANE DO
Provider Business Mailing Address
First Line : 6401 PRAIRIE ST STE 2600
Second Line :
City : NORTON SHORES
State : MI
Zip : 49444-7842
Country : US
Telephone Number : 231-672-7900
Fax Number : 231-672-7931
Provider Business Practice Location Address
First Line : 6401 PRAIRIE ST STE 2600
Second Line :
City : NORTON SHORES
State : MI
Zip : 49444-7842
Country : US
Telephone Number : 231-672-7900
Fax Number : 231-672-7931
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2020
Last Update Date : 11/02/2023

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Directions to “ RACHAEL NICOLE LANE DO” Practice Location

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