MEDICARE: DR. JOHN BAISTAD DOLVEN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	5101005203	MI

General Provider Information

NPI Number	:	1487022489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BAISTAD DOLVEN DO

Provider Business Mailing Address
First Line	:	3441 LAPEER RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503
Country	:	US
Telephone Number	:	810-813-9579
Fax Number	:

Provider Business Practice Location Address
First Line	:	3441 LAPEER RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503
Country	:	US
Telephone Number	:	810-813-9579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	09/08/2015

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