Healthcare Provider Details

I. General information

NPI: 1669470035
Provider Name (Legal Business Name): JOHN BOYLE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD SUITE # 2110
WEST BLOOMFIELD MI
48323-2184
US

IV. Provider business mailing address

2300 HAGGERTY RD SUITE # 2110
WEST BLOOMFIELD MI
48323-2184
US

V. Phone/Fax

Practice location:
  • Phone: 248-926-1411
  • Fax: 248-926-5338
Mailing address:
  • Phone: 248-926-1411
  • Fax: 248-926-5338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJB014559
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: