MEDICARE: MICHAEL JAMES DOOLIN FF/PM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	060360179	IL

General Provider Information

NPI Number	:	1033760715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAMES DOOLIN FF/PM

Provider Business Mailing Address
First Line	:	1338 S CLINTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-5037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 S CLINTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-5037
Country	:	US
Telephone Number	:	312-745-4189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	09/24/2019

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