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		CA

General Provider Information

NPI Number	:	1922233105
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4924 BALBOA BLVD
Second Line	:	SUITE 138
City	:	ENCINO
State	:	CA
Zip	:	91316-3402
Country	:	US
Telephone Number	:	818-212-9943
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARTIN A KOYLE
Credential	:
Telephone Number	:	818-212-9943

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	05/18/2009

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Directions to “MA KOYLE INC ” Practice Location

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