Individual
COLLEEN KANE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
75 SHELDON AVE SE STE 100, GRAND RAPIDS, MI 49503-4224
(616) 391-6120
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301098237
MI
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
4301098237
MI
208000000X
Pediatrics Physician
4301098237
MI
Other
Enumeration date
06/09/2011
Last updated
10/06/2021
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