Individual
LANE THOMAS OLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3443 FARR RD, FRUITPORT, MI 49415-8779
(231) 672-2900
Mailing address
475 E CHADWICK DR, MUSKEGON, MI 49445-2319
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5151015795
MI
Other
Enumeration date
04/26/2022
Last updated
04/26/2022
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