Provider Demographics
NPI:1033140223
Name:DOLAN, MICHELLE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:DOLAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE STREET SE
Mailing Address - Street 2:MMC 669 UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-0622
Mailing Address - Fax:612-626-2696
Practice Address - Street 1:420 DELAWARE STREET SE, 760 MAYO MEMORIAL BUILDING
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-0622
Practice Address - Fax:612-626-2696
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-05-11
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Provider Licenses
StateLicense IDTaxonomies
MN42857207SC0300X, 207SG0203X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN160147400Medicaid
MNHP41076OtherHEALTHPARTNERS
MN140155OtherUCARE
MN009A5DOOtherBCBS
MN1131521OtherARAZ
MN1025646OtherPREFERRED ONE
MN11-00106OtherMEDICA CHOICE & PRIMARY
MN11-00106OtherMEDICA CHOICE & PRIMARY