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General NPI Number Information
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NPI Number | 1548793219
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Entity Type | Individual
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Provider Name | ALISSA JEAN DOLL
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Gender | Female
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Dates
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Enumeration Date | 04/09/2017
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 4123 DUTCHMANS LN STE 607
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City | LOUISVILLE
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State | KY
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Zip | 40207-4725
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Country | US
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Telephone | 502-899-6470
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Fax | 502-899-6479
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone |
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Fax |
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 59341
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 59341
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License Number State | KY
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