Healthcare Provider Details

I. General information

NPI: 1306895214
Provider Name (Legal Business Name): JANIS E BYRD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 PARK AVE 1ST FLOOR
COLUMBUS WI
53925-1618
US

IV. Provider business mailing address

1513 PARK AVE
COLUMBUS WI
53925-1618
US

V. Phone/Fax

Practice location:
  • Phone: 920-623-9611
  • Fax: 920-623-1788
Mailing address:
  • Phone: 920-623-9611
  • Fax: 920-623-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21152-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: