Healthcare Provider Details

I. General information

NPI: 1740270180
Provider Name (Legal Business Name): MIKAL JANELLE DORSETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 22ND ST SUITE 300
LUBBOCK TX
79410-1305
US

IV. Provider business mailing address

20801 COUNTY ROAD 1940
LUBBOCK TX
79423-6617
US

V. Phone/Fax

Practice location:
  • Phone: 806-788-1212
  • Fax: 806-788-1253
Mailing address:
  • Phone: 806-863-2093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberF9899
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: