Provider Demographics
NPI:1467460170
Name:DOLMAN, HEATHER S (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:DOLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-4195
Mailing Address - Fax:313-993-8669
Practice Address - Street 1:4160 JOHN R
Practice Address - Street 2:HARPER PROFESSIONAL BLDG STE 615
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-4195
Practice Address - Fax:313-993-8669
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076367208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN987653000Medicaid
MNP00427429OtherRAILROAD MEDICARE
I57723Medicare UPIN
MI0P30630551Medicare PIN
MN020002272Medicare PIN