Healthcare Provider Details

I. General information

NPI: 1447708797
Provider Name (Legal Business Name): MICHAEL JAMES MACLEOD COYLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 STIRLING CENTER PL
LAKE MARY FL
32746-4856
US

IV. Provider business mailing address

773 STIRLING CENTER PL
LAKE MARY FL
32746-4856
US

V. Phone/Fax

Practice location:
  • Phone: 407-977-4130
  • Fax:
Mailing address:
  • Phone: 407-977-4130
  • Fax: 407-834-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9109768
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: