1982791513 NPI number — DOYLE E CALLEY M.D.

Table of content: DOYLE E CALLEY M.D. (NPI 1982791513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982791513 NPI number — DOYLE E CALLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLEY
Provider First Name:
DOYLE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982791513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2760 KEEFER HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYONS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48851-9707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-855-2140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2760 KEEFER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYONS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48851-9707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-855-2140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  DC041390 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: 4301041390 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02630 . This is a "P HEALTH HOSPITAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 35937 . This is a "P HEALTH OFFICE PAY TO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103176367 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200000005939 . This is a "PHPMM OFFICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3176367 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700C460060 . This is a "BCBS HOSPITAL GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700C460070 . This is a "BCBS OFFICE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1003025 . This is a "MCLAREN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104424989 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200000001667 . This is a "PHPMM HOSPITAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383218134 . This is a "TRICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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