Provider Demographics
NPI:1346464575
Name:DOLAN, NICOLE ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELLEN
Last Name:DOLAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16360 26 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:MACOMB TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48042
Mailing Address - Country:US
Mailing Address - Phone:586-336-2390
Mailing Address - Fax:586-372-3979
Practice Address - Street 1:12150 30 MILE RD
Practice Address - Street 2:STE 201
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48095-2035
Practice Address - Country:US
Practice Address - Phone:586-336-2390
Practice Address - Fax:586-336-2381
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016492207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology