Provider Demographics
NPI:1952398570
Name:HANDKE, LANE T (MD)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:T
Last Name:HANDKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E MAIN ST
Mailing Address - Street 2:PO BOX 67
Mailing Address - City:PIERCE
Mailing Address - State:NE
Mailing Address - Zip Code:68767-1314
Mailing Address - Country:US
Mailing Address - Phone:402-329-4195
Mailing Address - Fax:402-329-4197
Practice Address - Street 1:215 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PIERCE
Practice Address - State:NE
Practice Address - Zip Code:68767-1314
Practice Address - Country:US
Practice Address - Phone:402-329-4195
Practice Address - Fax:402-329-4197
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1140005OtherMEDICARE
NE10025917400Medicaid
45540OtherBCBS OF NEBRASKA