Provider Demographics
NPI:1619139821
Name:O'BOYLE, JEFF (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:O'BOYLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 W EISENHOWER CIR STE E
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5868
Mailing Address - Country:US
Mailing Address - Phone:734-562-0774
Mailing Address - Fax:
Practice Address - Street 1:955 W EISENHOWER CIR STE E
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5868
Practice Address - Country:US
Practice Address - Phone:734-562-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine