Provider Demographics
NPI:1982791513
Name:CALLEY, DOYLE E (MD)
Entity Type:Individual
Prefix:
First Name:DOYLE
Middle Name:E
Last Name:CALLEY
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 1:2760 KEEFER HWY
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:MI
Mailing Address - Zip Code:48851-9707
Mailing Address - Country:US
Mailing Address - Phone:989-855-2140
Mailing Address - Fax:
Practice Address - Street 1:2760 KEEFER HWY
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:MI
Practice Address - Zip Code:48851-9707
Practice Address - Country:US
Practice Address - Phone:989-855-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDC041390207R00000X
MI4301041390208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI02630OtherP HEALTH HOSPITAL
MI35937OtherP HEALTH OFFICE PAY TO
MI103176367Medicaid
MI200000005939OtherPHPMM OFFICE
MI3176367OtherMOLINA
MI700C460060OtherBCBS HOSPITAL GROUP
MI700C460070OtherBCBS OFFICE GROUP
MI1003025OtherMCLAREN
MI104424989Medicaid
MI200000001667OtherPHPMM HOSPITAL
MI383218134OtherTRICARE
MI35937OtherP HEALTH OFFICE PAY TO
MI700C460060OtherBCBS HOSPITAL GROUP
B43307Medicare UPIN
MI103176367Medicaid