Healthcare Provider Details

I. General information

NPI: 1871900191
Provider Name (Legal Business Name): DAVID MICHAEL BYRNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S COLUMBIA RD
GRAND FORKS ND
58201-4036
US

IV. Provider business mailing address

1200 S COLUMBIA RD
GRAND FORKS ND
58201-4036
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-6000
  • Fax: 701-780-5772
Mailing address:
  • Phone: 701-780-6000
  • Fax: 701-780-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-10152
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14524
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: