Healthcare Provider Details

I. General information

NPI: 1700838307
Provider Name (Legal Business Name): ROBERT W BYRN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-747-3858
  • Fax: 765-747-3859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01061728A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: