Healthcare Provider Details

I. General information

NPI: 1336701366
Provider Name (Legal Business Name): MICHAEL R BYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2019
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W NORTH AVE FL 1
CHICAGO IL
60610-1042
US

IV. Provider business mailing address

711 W NORTH AVE FL 1
CHICAGO IL
60610-1042
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-1982
  • Fax:
Mailing address:
  • Phone: 312-337-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036159271
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: