Individual
MICHAEL JOHN DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, DPT
Contact information
Practice address
10133 DEVONSHIRE LN, MUNSTER, IN 46321-4376
(219) 381-1861
Mailing address
10133 DEVONSHIRE LN, MUNSTER, IN 46321-4376
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002268A
IN
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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