MEDICARE: MS. MELISSA ANN BYRAM 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	208000000X	Pediatrics Physician	57712	CO
2	208000000X	Pediatrics Physician	7272	NV
3	208000000X	Pediatrics Physician	59645	AZ

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740249945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA ANN BYRAM MD

Provider Business Mailing Address
First Line	:	PO BOX 10097
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85130-0020
Country	:	US
Telephone Number	:	520-836-3446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1856 E FLORENCE BLVD
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5303
Country	:	US
Telephone Number	:	520-836-5036
Fax Number	:	520-316-0365

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/21/2022

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