Healthcare Provider Details

I. General information

NPI: 1538130141
Provider Name (Legal Business Name): MICHAEL C BYRNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 05/02/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 COLLETON DR
CHARLESTON SC
29407-7302
US

IV. Provider business mailing address

1938A CHARLIE HALL BLVD.
CHARLESTON SC
29414-6099
US

V. Phone/Fax

Practice location:
  • Phone: 843-513-5916
  • Fax:
Mailing address:
  • Phone: 843-554-9313
  • Fax: 843-744-5961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20799
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: