Healthcare Provider Details

I. General information

NPI: 1013017946
Provider Name (Legal Business Name): JAMES R. DOLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LUTHER LN
PARK RIDGE IL
60068-1270
US

IV. Provider business mailing address

1700 LUTHER LN
PARK RIDGE IL
60068-1270
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-8180
  • Fax:
Mailing address:
  • Phone: 847-723-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number362169147
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: