MEDICARE: BYRON HAITAS 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
1	207RC0000X	Cardiovascular Disease Physician	MD018628	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275646119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRON HAITAS MD

Provider Business Mailing Address
First Line	:	2400 PATTERSON ST
Second Line	:	SUITE 304
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1562
Country	:	US
Telephone Number	:	615-342-5975
Fax Number	:	615-342-5919

Provider Business Practice Location Address
First Line	:	2400 PATTERSON STREETT
Second Line	:	SUITE 304
City	:	NASHVILLE
State	:	TN
Zip	:	37203
Country	:	US
Telephone Number	:	615-342-5975
Fax Number	:	615-342-5919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	01/07/2022

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Directions to “ BYRON HAITAS MD” Practice Location

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