Healthcare Provider Details

I. General information

NPI: 1033760715
Provider Name (Legal Business Name): MICHAEL JAMES DOOLIN FF/PM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 S CLINTON ST
CHICAGO IL
60607-5037
US

IV. Provider business mailing address

1338 S CLINTON ST
CHICAGO IL
60607-5037
US

V. Phone/Fax

Practice location:
  • Phone: 312-745-4189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number060360179
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: