Provider Demographics
NPI:1689606238
Name:LANESE, DONALD DAVID (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DAVID
Last Name:LANESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 LAKEVIEW PLAZA BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4774
Mailing Address - Country:US
Mailing Address - Phone:866-682-5454
Mailing Address - Fax:614-888-2227
Practice Address - Street 1:651 LAKEVIEW PLAZA BLVD STE E
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4774
Practice Address - Country:US
Practice Address - Phone:866-682-5454
Practice Address - Fax:614-888-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100162085R0202X
IN02002173A2085R0202X
KS5295372085R0202X
KY027342085R0202X
MI51010167202085R0202X
MDH00582632085R0202X
OH34001528L2085R0202X
WI435690212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE00579Medicare UPIN
OHLA037111Medicare ID - Type Unspecified