MEDICARE: MICHAEL PAUL DOLAN LLP

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	103TC0700X	Clinical Psychologist	6361008243	MI

General Provider Information

NPI Number	:	1447087093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PAUL DOLAN LLP

Provider Business Mailing Address
First Line	:	1106 E COBBLEFIELD CT
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-6305
Country	:	US
Telephone Number	:	586-238-5565
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 W ALLEGAN ST FL 7
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-1717
Country	:	US
Telephone Number	:	248-233-3994
Fax Number	:	517-481-2271

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

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	03/05/2026

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