Provider Demographics
NPI:1386677292
Name:BYRON ROAD MEDICAL GROUP PC
Entity Type:Organization
Organization Name:BYRON ROAD MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:MCLEARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-546-0200
Mailing Address - Street 1:1200 BYRON ROAD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:517-546-0200
Mailing Address - Fax:517-546-3218
Practice Address - Street 1:1200 BYRON ROAD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:517-546-0200
Practice Address - Fax:517-546-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0D76226Medicare ID - Type Unspecified