Individual
DOUGLAS J COYLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1789 SHAWANO AVE, GREEN BAY, WI 54303
(920) 499-1428
(920) 499-5808
Mailing address
1789 SHAWANO AVE, GREEN BAY, WI 54303-3243
(920) 499-1428
(920) 499-7080
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
42438-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14394
DEAN HEALTH
—
05
—
34468700
—
WI
01
—
4145510001
UNITED HEALTHCARE AMERICH
—
05
—
4793113
—
MI
05
—
4793122
—
MI
01
—
567565
DEAN HEALTH
—
Enumeration date
07/11/2006
Last updated
12/05/2017
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