Provider Demographics
NPI:1780892505
Name:LANE, ROBERT MICHAEL (AART)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:LANE
Suffix:
Gender:M
Credentials:AART
Other - Prefix:MR
Other - First Name:BOBBY
Other - Middle Name:M
Other - Last Name:LANE
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:AART
Mailing Address - Street 1:3642 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3227
Mailing Address - Country:US
Mailing Address - Phone:785-856-1226
Mailing Address - Fax:
Practice Address - Street 1:1403 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604
Practice Address - Country:US
Practice Address - Phone:785-783-8875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2202833247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist