Healthcare Provider Details

I. General information

NPI: 1447087093
Provider Name (Legal Business Name): MICHAEL PAUL DOLAN LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W ALLEGAN ST FL 7
LANSING MI
48933-1717
US

IV. Provider business mailing address

1106 E COBBLEFIELD CT
BLOOMINGTON IN
47401-6305
US

V. Phone/Fax

Practice location:
  • Phone: 248-233-3994
  • Fax: 517-481-2271
Mailing address:
  • Phone: 586-238-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361008243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: