Basic Information
Provider Information
NPI: 1992025969
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYLE
FirstName: SEAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 237 WILLIAM HOWARD TAFT RD
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452192610
CountryCode: US
TelephoneNumber: 5133519900
FaxNumber: 5133664491
Practice Location
Address1: 2123 AUBURN AVE
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452192906
CountryCode: US
TelephoneNumber: 5135853238
FaxNumber: 5135853254
Other Information
ProviderEnumerationDate: 06/01/2010
LastUpdateDate: 10/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X34.010915OHY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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