Provider Demographics
NPI:1669471900
Name:DOLE, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:DOLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR 10809
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:3408 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2312
Practice Address - Country:US
Practice Address - Phone:952-924-1053
Practice Address - Fax:952-924-0254
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2021-03-11
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Provider Licenses
StateLicense IDTaxonomies
MN29325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA94054Medicare UPIN