Individual
GEORGE W LANE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 400, PEORIA, IL 61614-5098
(309) 692-6644
(309) 692-8992
Mailing address
5401 N KNOXVILLE AVE, SUITE 400, PEORIA, IL 61614-5098
(309) 692-6644
(309) 692-8992
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
03064025
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036064025
—
IL
01
—
050053
HEALTH ALLIANCE
IL
01
—
148547
HEALTHLINK
IL
01
—
200041572
RR MEDICARE
IL
01
—
4281670001
DME
IL
01
—
7230175
BLUE CROSS BLUE SHIELD
IL
01
—
IL0102
JOHN DEERE
IL
Enumeration date
06/02/2006
Last updated
06/24/2011
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