Healthcare Provider Details

I. General information

NPI: 1831884824
Provider Name (Legal Business Name): MITCHELL BAYNE MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE DEPT OF
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

255 EAST CHICAGO AVE
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2902
  • Fax:
Mailing address:
  • Phone: 312-227-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036.180387
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: