Provider Demographics
NPI:1447233879
Name:MOYLAN, DONALD F (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:F
Last Name:MOYLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:31157 WOODWARD AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0926
Mailing Address - Country:US
Mailing Address - Phone:248-336-0123
Mailing Address - Fax:248-336-3190
Practice Address - Street 1:31157 WOODWARD AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0926
Practice Address - Country:US
Practice Address - Phone:248-336-0123
Practice Address - Fax:248-336-3190
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301041177208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA77372OtherHAP
MI3406334131OtherBCBSM INDIVIDUAL ID
MI4366812OtherAETNA
MIDM041177OtherBCBSM OTHER IDENTIFIER
MIC5868OtherMCARE
MIDM041177OtherBCBSM LICENSE NUMBER
MI34104505OtherRAILROAD MEDICARE
MI4973523Medicaid
MI4366812OtherAETNA
MI3406334131OtherBCBSM INDIVIDUAL ID