Healthcare Provider Details

I. General information

NPI: 1497755060
Provider Name (Legal Business Name): DAMON B. COYLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SHELBYVILLE RD SUITE #220
LOUISVILLE KY
40223-2992
US

IV. Provider business mailing address

9800 SHELBYVILLE RD SUITE #220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 502-429-8585
  • Fax: 855-656-7325
Mailing address:
  • Phone: 502-429-8585
  • Fax: 855-656-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37729
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number37729
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: