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General NPI Number Information
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NPI Number | 1043393168
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Entity Type | Organization
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Legal Business Name | MARYAM K DOYLE MD SC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 12203 CORPORATE PKWY
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City | MEQUON
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State | WI
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Zip | 53092-3388
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Country | US
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Telephone | 262-387-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 4555 W SCHROEDER DR SUITE #170
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City | MILWAUKEE
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State | WI
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Zip | 53223-1475
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Country | US
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Telephone | 414-365-3210
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Fax | 414-365-3225
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MARYAM K DOYLE
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Credential | MD
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Telephone | 414-365-3210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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