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Contact Information

MICHAEL J LANE, PA-C
388 E. PARKCENTER BLVD.
BOISE, ID83706
 Phone: 208-424-9101
 Fax: 208-424-5072
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for MICHAEL J LANE · (Male)

NPI # 1669415188
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 06/13/2006
Last updated 12/05/2014 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • ID License # M7247
  • ID License # PA377
  • ID Medicaid 806272300
  • ID Medicaid 806272301
  • ID Other DI593 BLUE CROSS OF ID
  • ID Other 000010140814 BLUE SHIELD OF ID; BOISE
  • ID Other 000010145063 BLUE SHIELD OF ID; EMMETT
Hospital affiliation(s)
  • ST LUKES REGIONAL MEDICAL CENTER - (Acute Care)
    190 EAST BANNOCK STREET
    BOISE, ID 83712
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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