Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 19501 | MT |
NPI | 1033186655 |
---|---|
Provider Name | Michael Dolecki |
First Address | Hamilton, MT 59840-2338 |
Second Address | Hamilton, MT 59840-2345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033186655 | (05) | ID |
1033186655 | (05) | MT |
E92572 | (02) |