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General NPI Number Information
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NPI Number | 1265460463
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Entity Type | Individual
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Provider Name | MICHAEL PHILLIP DOYLE MEDICAL DOCTOR
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 2074 LAKE TAHOE BLVD STE 9
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6407
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Country | US
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Telephone | 530-541-6100
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Fax | 530-541-5945
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Provider Business Mailing Address
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Address Line | 2074 LAKE TAHOE BLVD STE 9
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6407
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Country | US
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Telephone | 530-541-6100
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Fax | 530-541-5945
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G71419
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License Number State | CA
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