Provider Demographics
NPI:1740270180
Name:DORSETT, MIKAL JANELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MIKAL
Middle Name:JANELLE
Last Name:DORSETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20801 COUNTY ROAD 1940
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6617
Mailing Address - Country:US
Mailing Address - Phone:806-863-2093
Mailing Address - Fax:
Practice Address - Street 1:3405 22ND ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1305
Practice Address - Country:US
Practice Address - Phone:806-788-1212
Practice Address - Fax:806-788-1253
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9899207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF9899OtherSTATE ID #
TXC19992Medicare UPIN
TX00L48FMedicare ID - Type Unspecified