Provider Demographics
NPI:1699876219
Name:COYLE, CAROLYN ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANNE
Last Name:COYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:ANNE
Other - Last Name:COYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10170 NICHOLAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2174
Mailing Address - Country:US
Mailing Address - Phone:402-391-3800
Mailing Address - Fax:402-934-1676
Practice Address - Street 1:10170 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2174
Practice Address - Country:US
Practice Address - Phone:402-391-3800
Practice Address - Fax:402-934-1676
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10112207RR0500X
NE31999207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT99760OtherBCBS OF MT
MT0142480Medicaid
MT0142480Medicaid