Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 362169147 | IL |
NPI | 1013017946 |
---|---|
Provider Name | Dr. James R. Dolan |
First Address | Park Ridge, IL 60068-1270 |
Second Address | Park Ridge, IL 60068-1270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 30/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036070164 | (05) | IL |
E18973 | (02) | IL |