Provider Demographics
NPI:1881860310
Name:DOYLE, MICHAEL EDWARD (M D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:DOYLE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 5TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5030
Mailing Address - Country:US
Mailing Address - Phone:203-324-4747
Mailing Address - Fax:203-324-4743
Practice Address - Street 1:22 5TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5030
Practice Address - Country:US
Practice Address - Phone:203-324-4747
Practice Address - Fax:203-324-4743
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF75985Medicare UPIN