Healthcare Provider Details

I. General information

NPI: 1649610239
Provider Name (Legal Business Name): MICHAEL BYRNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W HARRISON ST
CHICAGO IL
60612-3706
US

IV. Provider business mailing address

307 N MICHIGAN AVE STE 1008
CHICAGO IL
60601-5310
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5375
  • Fax:
Mailing address:
  • Phone: 312-248-3358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036140464
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: