Provider Demographics
NPI:1245201102
Name:BYRNES, MICHAEL JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BYRNES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2849
Mailing Address - Country:US
Mailing Address - Phone:610-239-8357
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 5250 NEW JERSEY AVE.
Practice Address - Street 2:
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640
Practice Address - Country:US
Practice Address - Phone:609-562-5707
Practice Address - Fax:609-562-3153
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-010566-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine