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Individual

AISHA LANE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7900 W 75TH ST, BRIDGEVIEW, IL 60455-1237
(708) 612-3956
Mailing address
6801 W 73RD ST UNIT 922, BEDFORD PARK, IL 60499-5332
(708) 612-3956

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
238000384
IL
246ZC0007X
Surgical Assistant
238000384
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
246ZC0007X
TAXONOMY #
IL
Enumeration date
11/13/2013
Last updated
04/22/2019
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