Provider Demographics
NPI:1891028460
Name:PHILIP E. LANE MD, SC
Entity Type:Organization
Organization Name:PHILIP E. LANE MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-953-0866
Mailing Address - Street 1:21707 W OLD BARN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-1612
Mailing Address - Country:US
Mailing Address - Phone:847-438-5447
Mailing Address - Fax:847-438-9337
Practice Address - Street 1:2947 W BONNIE BROOK LN
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-2838
Practice Address - Country:US
Practice Address - Phone:847-662-8009
Practice Address - Fax:847-662-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-051264207L00000X
IL036-0300742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty