Lane, Michael J

Lane, Michael J is an individual health care provider with primary practice located at 388 E. Parkcenter Blvd. , Boise ID 83706. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Allopathic & Osteopathic Physicians / Dermatology. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Lane, Michael J can be contacted via phone (208) 424-9101.

Contact Information

Primary practice address
388 E. Parkcenter Blvd. Boise ID 83706
Phone: (208) 424-9101
Fax: (208) 424-5072
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA377 Idaho
Allopathic & Osteopathic Physicians / Dermatology 207N00000X M7247 Idaho

Profile Details

NPI number 1669415188
LBN Legal business name Lane, Michael J
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Dec 5th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669415188 NPPES
Idaho MEDICAID 806272300
Idaho MEDICAID 806272301
Idaho Other 000010140814
Idaho Other DI593
Idaho Other 000010145063

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