Provider Demographics
NPI:1932190642
Name:LANE, MINDY KATHRYN (DO)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:KATHRYN
Last Name:LANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-4010
Mailing Address - Fax:517-913-4011
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-4010
Practice Address - Fax:517-913-4011
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013104208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M21440055OtherMEDICARE PLUS BLUE
MIP00456403OtherRAILROAD MEDICARE
MI1020388OtherMCLAREN HEALTH PLAN-MEDICAID
MI200000002269OtherPHP FAMILYCARE
MI1020388OtherMCLAREN HEALTH ADVANTAGE
MI200000002269OtherPHP
MI0253302804OtherBCBS/BCN
MI1020388OtherFIRST HEALTH
MI1020388OtherCURANET
MI1020388OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI4311822Medicaid
MI4911173Medicaid
MIP00456403OtherRAILROAD MEDICARE
MIM59660007Medicare ID - Type Unspecified
MI4311822Medicaid