Provider Demographics
NPI:1376503151
Name:O'BYRNE, RACHEL EILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:EILEEN
Last Name:O'BYRNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21099 MASONIC BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1045
Mailing Address - Country:US
Mailing Address - Phone:586-296-6213
Mailing Address - Fax:586-296-8180
Practice Address - Street 1:21099 MASONIC BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1045
Practice Address - Country:US
Practice Address - Phone:586-296-6213
Practice Address - Fax:586-296-8180
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4760631Medicaid
MI700E031610OtherBCBS GROUP NUMBER
MI4760631Medicaid
MIMI3971Medicare PIN
MI4760631Medicaid