Provider Demographics
NPI:1326115528
Name:BYERS, KEITH E (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:E
Last Name:BYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35040 CHARDON RD # SUITE 6200
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9055
Mailing Address - Country:US
Mailing Address - Phone:440-953-9014
Mailing Address - Fax:440-953-9173
Practice Address - Street 1:35040 CHARDON RD # SUITE 6200
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9055
Practice Address - Country:US
Practice Address - Phone:440-953-9014
Practice Address - Fax:440-953-9173
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH39718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0402479Medicaid
A78472Medicare UPIN
OH0402479Medicaid