Provider Demographics
NPI:1427164854
Name:DOYLE, DONALD C (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:DOYLE
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 1:5555 GULL RD
Mailing Address - Street 2:#201
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49040
Mailing Address - Country:US
Mailing Address - Phone:269-385-2781
Mailing Address - Fax:269-343-3450
Practice Address - Street 1:5555 GULL RD
Practice Address - Street 2:#201
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49040
Practice Address - Country:US
Practice Address - Phone:269-385-2781
Practice Address - Fax:269-343-3450
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4232845Medicaid
MIDD035080OtherBX
MI383540531OtherEIN
MI0N14100Medicare ID - Type Unspecified
MI4232845Medicaid