Provider Demographics
NPI:1497718936
Name:DOTTI, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:DOTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1050 E. HWY 114
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-329-8364
Mailing Address - Fax:817-329-1285
Practice Address - Street 1:1050 E STATE HIGHWAY 114
Practice Address - Street 2:STE 100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5253
Practice Address - Country:US
Practice Address - Phone:817-329-8364
Practice Address - Fax:817-329-1285
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85X332Medicare ID - Type Unspecified
TXF70981Medicare UPIN