Individual
DR. MICHAEL L DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2900 16TH ST, BEDFORD, IN 47421-3510
(812) 676-4102
(812) 676-4106
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02006851A
IN
208D00000X
General Practice Physician
312385
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
312385
NEW YORK STATE MEDICAL LICENSE NUMBER
NY
Enumeration date
04/11/2018
Last updated
07/25/2022
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