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NPI Code Detail

MEDICARE: JENNIFER BYRD MD

MEDICARE:   JENNIFER  BYRD  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036106286IL

General Provider Information

NPI Number : 1033232749
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER BYRD MD
Provider Business Mailing Address
First Line : 2703 W BELDEN AVE
Second Line : APT. 1
City : CHICAGO
State : IL
Zip : 60647-3011
Country : US
Telephone Number : 773-384-2431
Fax Number : 708-747-3497
Provider Business Practice Location Address
First Line : 1536 VINCENNES AVE
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-3458
Country : US
Telephone Number : 708-756-1135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 01/03/2012

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