Provider Demographics
NPI:1134128549
Name:LANE, ANETTE C (MD)
Entity Type:Individual
Prefix:
First Name:ANETTE
Middle Name:C
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 SOUTHEASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5828
Mailing Address - Country:US
Mailing Address - Phone:317-803-2515
Mailing Address - Fax:317-803-2519
Practice Address - Street 1:6300 SOUTHEASTERN AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-5828
Practice Address - Country:US
Practice Address - Phone:317-803-2515
Practice Address - Fax:317-803-2519
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054524207Q00000X
IN01054524A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01054524OtherMEDICAL LICENCE
IN200956680Medicaid
IN200280840AMedicaid
IN200280840AMedicaid
INM400019262Medicare PIN
INM100019232Medicare PIN
IN000000655777OtherANTHEM