Provider Demographics
NPI:1043393168
Name:MARYAM K DOYLE MD SC
Entity Type:Organization
Organization Name:MARYAM K DOYLE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-365-3210
Mailing Address - Street 1:4555 W SCHROEDER DR
Mailing Address - Street 2:SUITE #170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1475
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3225
Practice Address - Street 1:12203 CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3388
Practice Address - Country:US
Practice Address - Phone:262-387-8383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31773400Medicaid
WI31773400Medicaid
WI000073925Medicare PIN
WI000046231Medicare PIN
WI000004021Medicare PIN