Provider Demographics
NPI:1285191387
Name:BYRD, MICHAEL MAURICE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MAURICE
Last Name:BYRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6412 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2773
Mailing Address - Country:US
Mailing Address - Phone:816-923-1114
Mailing Address - Fax:816-861-0071
Practice Address - Street 1:6412 E 87TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138-2773
Practice Address - Country:US
Practice Address - Phone:816-923-1114
Practice Address - Fax:816-861-0071
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1551Medicaid