Provider Demographics
NPI:1851430417
Name:LANE, MODISH JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MODISH
Middle Name:JEAN
Last Name:LANE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:23250 CHAGRIN BLVD
Mailing Address - Street 2:110
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5470
Mailing Address - Country:US
Mailing Address - Phone:216-591-1862
Mailing Address - Fax:216-591-9399
Practice Address - Street 1:23250 CHAGRIN BLVD
Practice Address - Street 2:110
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5470
Practice Address - Country:US
Practice Address - Phone:216-591-1862
Practice Address - Fax:216-591-9399
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
OH35049505207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology