Provider Demographics
NPI:1023074879
Name:DOYLE, DOUGLAS A (DO)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:DOYLE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-0260
Practice Address - Street 1:2221 HEALTH DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9700
Practice Address - Country:US
Practice Address - Phone:616-252-5710
Practice Address - Fax:616-252-5780
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101014374207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18-5-41-1291-4OtherBCBS PIN
MI1023074879Medicaid
MIM53750086Medicare PIN