Individual
LISA A. LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
104 NICHOLAS PL, AVILLA, IN 46710-0069
(260) 897-3308
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01046721
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000364996
ANTHEM
IN
01
—
000000570556
ANTHEM
IN
05
—
200179590A
—
IN
01
—
P00354178
RAILROAD MEDICARE
IN
Enumeration date
09/14/2005
Last updated
01/20/2026
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