Provider Demographics
NPI:1669641189
Name:MICHAEL P. DOYLE, M.D.
Entity Type:Organization
Organization Name:MICHAEL P. DOYLE, M.D.
Other - Org Name:LAKE TAHOE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-541-6100
Mailing Address - Street 1:2074 LAKE TAHOE BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6417
Mailing Address - Country:US
Mailing Address - Phone:530-541-6100
Mailing Address - Fax:530-541-5945
Practice Address - Street 1:2074 LAKE TAHOE BLVD STE 9
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6417
Practice Address - Country:US
Practice Address - Phone:530-541-6100
Practice Address - Fax:530-541-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71419208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV7876OtherNV LICENCE
CAGR0005620Medicaid
CAG71419OtherCA LICENCE
CAF31504Medicare UPIN
CAG71419OtherCA LICENCE