Healthcare Provider Details

I. General information

NPI: 1063545317
Provider Name (Legal Business Name): MATTHEW CHRISTOPHER BYRNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N HILLSIDE ST
WICHITA KS
67214-4910
US

IV. Provider business mailing address

3817 W CORNELISON ST
WICHITA KS
67203-1032
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-5650
  • Fax: 601-579-5240
Mailing address:
  • Phone: 601-268-5650
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number04-30808
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number29844
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number787
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: