Provider Demographics
NPI:1497755060
Name:COYLE, DAMON B (MD)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:B
Last Name:COYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:SUITE #220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:9800 SHELBYVILLE RD
Practice Address - Street 2:SUITE #220
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2992
Practice Address - Country:US
Practice Address - Phone:502-429-8585
Practice Address - Fax:855-656-7325
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37729208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200423220Medicaid
KY64063134Medicaid
KY64063134Medicaid
IN200423220Medicaid
KY0682412Medicare PIN
IN200423220Medicaid
KY2442591000Medicaid
IN181540IMedicare ID - Type UnspecifiedPROVIDER NUMBER