Basic Information
| Provider Information | |||||||||
| NPI: | 1861451403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOYLE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7590 AUBURN ROAD, SUITE 014 | ||||||||
| Address2: | ATTN: MED STAF | ||||||||
| City: | CONCORD TWP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440779176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403541899 | ||||||||
| FaxNumber: | 4403541845 | ||||||||
| Practice Location | |||||||||
| Address1: | 36100 EUCLID AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409518360 | ||||||||
| FaxNumber: | 4409519408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35-045614 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 000000130211 | 01 | OH | ANTHEM | OTHER | 18958 | 01 | OH | QUALCHOICE | OTHER | 341313510TD | 01 | OH | SUMMACARE | OTHER | 060027313 | 01 | OH | RAILROAD MED B | OTHER | 2597481 | 01 | OH | UNITED HEALTHCARE | OTHER | 0589911 | 05 | OH | MEDICAID | 264168 | 01 | OH | FEDERAL BLACK LUNG | OTHER | 4007184 | 01 | OH | AETNA | OTHER |