Provider Demographics
NPI:1861802621
Name:DOLAN, PATRICK
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:DOLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAISUKE
Other - Middle Name:
Other - Last Name:TOMIYAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 W HUBBARD ST UNIT 603
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1990 LARKIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5827
Practice Address - Country:US
Practice Address - Phone:847-289-5727
Practice Address - Fax:847-888-5469
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36145370208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation