Provider Demographics
NPI:1932190642
Name:LANE, MINDY KATHRYN (DO)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:KATHRYN
Last Name:LANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MARY ST STE 520
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1682
Mailing Address - Country:US
Mailing Address - Phone:812-424-8231
Mailing Address - Fax:
Practice Address - Street 1:520 MARY ST STE 520
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1682
Practice Address - Country:US
Practice Address - Phone:812-424-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013104208600000X
IN02008209A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1020388OtherCURANET
IN02008209BOtherCSR
MI1020388OtherMCLAREN HEALTH PLAN-MEDICAID
MI4911173Medicaid
MI200000002269OtherPHP
MI0M21440055OtherMEDICARE PLUS BLUE
IN02008209AOtherIN LICENSE
MI1020388OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1020388OtherFIRST HEALTH
MI4311822Medicaid
MIP00456403OtherRAILROAD MEDICARE
MI200000002269OtherPHP FAMILYCARE
MIP00456403OtherRAILROAD MEDICARE
MIM59660007Medicare ID - Type Unspecified
MI4311822Medicaid