Individual
MICHAEL A DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO FACOS
Contact information
Practice address
1905 E. HUEBBE PARKWAY, BELOIT HEALTH SYSTEM INC., BELOIT, WI 53511-1842
(608) 364-2200
(608) 364-2705
Mailing address
1905 E. HUEBBE PARKWAY, BELOIT HEALTH SYSTEM INC., BELOIT, WI 53511-1842
(608) 364-2200
(608) 364-2705
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
036-075916
IL
208800000X
Urology Physician
Primary
33488021
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10631
DEAN HEALTH PLAN HMO
—
05
—
1831107671
—
WI
Enumeration date
08/04/2006
Last updated
10/19/2011
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