MEDICARE: DR. MICHAEL JOHN BYRNES D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS-010566-L	PA

General Provider Information

NPI Number	:	1245201102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN BYRNES D.O.

Provider Business Mailing Address
First Line	:	221 DONNA DR
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-2849
Country	:	US
Telephone Number	:	610-239-8357
Fax Number	:

Provider Business Practice Location Address
First Line	:	BUILDING 5250 NEW JERSEY AVE.
Second Line	:
City	:	FORT DIX
State	:	NJ
Zip	:	08640
Country	:	US
Telephone Number	:	609-562-5707
Fax Number	:	609-562-3153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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