MEDICARE: MR. MICHAEL DOLAN ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1699814376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DOLAN ATC

Provider Business Mailing Address
First Line	:	395 MILL ST
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5152
Country	:	US
Telephone Number	:	716-888-2964
Fax Number	:	716-888-3219

Provider Business Practice Location Address
First Line	:	2001 MAIN ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14208-1035
Country	:	US
Telephone Number	:	716-888-2964
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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