Basic Information
| Provider Information | |||||||||
| NPI: | 1457354680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYLE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4437 STATE ROUTE 159 STE G15 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456017065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794598 | ||||||||
| FaxNumber: | 7407794599 | ||||||||
| Practice Location | |||||||||
| Address1: | 4437 STATE ROUTE 159 | ||||||||
| Address2: | STE G15 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456017065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794598 | ||||||||
| FaxNumber: | 7407794599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | 36002135B | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0528567 | 05 | OH | MEDICAID |