Provider Demographics
NPI:1841429958
Name:LANE, MELISSA (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:STE 105
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5306
Mailing Address - Country:US
Mailing Address - Phone:913-782-8487
Mailing Address - Fax:913-782-4634
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:STE 105
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5306
Practice Address - Country:US
Practice Address - Phone:913-782-8487
Practice Address - Fax:913-782-4634
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-35938207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200966790CMedicaid
KS033D00106Medicare PIN