Provider Demographics
NPI:1437530128
Name:DOYLE, KEVIN
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:DOYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 PINKERTON LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1513
Mailing Address - Country:US
Mailing Address - Phone:740-891-9000
Mailing Address - Fax:888-454-5157
Practice Address - Street 1:2725 PINKERTON LN
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1513
Practice Address - Country:US
Practice Address - Phone:740-891-9000
Practice Address - Fax:888-454-5157
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.067496208000000X
OH35.137537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0373801Medicaid