MEDICARE: JAMES LANE JR. M.D.

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	174400000X	Specialist	35-044197	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376512640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LANE JR. M.D.

Provider Business Mailing Address
First Line	:	5 SEVERANCE CIR
Second Line	:	SUITE 705
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1566
Country	:	US
Telephone Number	:	216-381-1311
Fax Number	:	216-381-2606

Provider Business Practice Location Address
First Line	:	5 SEVERANCE CIR
Second Line	:	SUITE 705
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1566
Country	:	US
Telephone Number	:	216-381-1311
Fax Number	:	216-381-2606

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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