Healthcare Provider Details

I. General information

NPI: 1063477164
Provider Name (Legal Business Name): ELIZABETH M DOYLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HUSTON DR
SHEPHERDSVILLE KY
40165-7250
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-955-7311
  • Fax: 502-955-9694
Mailing address:
  • Phone: 502-272-5100
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39199
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39199
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: