Individual
CHARLES A. LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6810 STATE ROUTE 162 STE 100, MARYVILLE, IL 62062-8560
(618) 288-5711
(618) 288-3647
Mailing address
6810 STATE ROUTE 162 STE 100, MARYVILLE, IL 62062-8560
(618) 288-3616
(618) 288-3647
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036083769
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
353524701001
—
IL
Enumeration date
12/06/2006
Last updated
03/09/2020
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