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Individual
AUSTIN LANE SEDICUM III
Active
Individual
AUSTIN LANE SEDICUM III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC005511
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
063479Q2K
MEDICARE INDIVIDUAL
—
01
—
063480
MEDICARE PIN
—
01
—
1417165
BS INDIVIDUAL
—
01
—
1418639
BS GROUP
—
01
—
2103588000
KEYSTONE INDIVIDUAL GROUP
—
01
—
2105345000
KEYSTONE GROUP
—
01
—
2941264
AETNA HMO PIN
—
01
—
50010317
CAPITAL GROUP
—
01
—
50016192
CAPITAL INDIVIDUAL
—
01
—
7802379
AETNA PPO PIN
—
Enumeration date
11/30/2006
Last updated
03/07/2023
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