Provider Demographics
NPI:1457389884
Name:DORLE, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DORLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:811 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3559
Mailing Address - Country:US
Mailing Address - Phone:320-631-7200
Mailing Address - Fax:320-632-0534
Practice Address - Street 1:811 2ND ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3559
Practice Address - Country:US
Practice Address - Phone:320-631-7200
Practice Address - Fax:320-632-0534
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42176208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN338514100Medicaid
MNF41342Medicare UPIN
MN020001380Medicare PIN