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General NPI Number Information
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NPI Number | 1033140223
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Entity Type | Individual
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Provider Name | MICHELLE MARIE DOLAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 420 DELAWARE STREET SE, 760 MAYO MEMORIAL BUILDING UNIVERSITY OF MINNESOTA PHYSICIANS
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-626-0622
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Fax | 612-626-2696
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Provider Business Mailing Address
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Address Line | 420 DELAWARE STREET SE MMC 669 UNIVERSITY OF MINNESOTA PHYSICIANS
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-626-0622
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Fax | 612-626-2696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SC0300X
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Taxonomy Name | Clinical Cytogenetics Physician
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License Number | 42857
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207SG0203X
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Taxonomy Name | Clinical Molecular Genetics Physician
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License Number | 42857
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 42857
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License Number State | MN
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