Healthcare Provider Details

I. General information

NPI: 1588960165
Provider Name (Legal Business Name): MICHAEL DOLEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 WASHINGTON AVE SUITE 300
ALBANY NY
12206-1068
US

IV. Provider business mailing address

1365 WASHINGTON AVE SUITE 300
ALBANY NY
12206-1068
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-4704
  • Fax: 518-489-0512
Mailing address:
  • Phone: 518-489-4704
  • Fax: 518-489-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006403
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: