MEDICARE: MA KOYLE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	29391	CO

General Provider Information

NPI Number	:	1407008915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MA KOYLE INC

Provider Business Mailing Address
First Line	:	4924 BALBOA BLVD
Second Line	:	SUITE 138
City	:	ENCINO
State	:	CA
Zip	:	91316-3402
Country	:	US
Telephone Number	:	818-915-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 BLAKE ST
Second Line	:	SUITE 101
City	:	DENVER
State	:	CO
Zip	:	80202-1289
Country	:	US
Telephone Number	:	818-915-1199
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MARTIN ALLEN KOYLE
Credential	:
Telephone Number	:	818-915-1199

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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Directions to “MA KOYLE INC ” Practice Location

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