Provider Demographics
NPI:1447215181
Name:BYRUM, HENRY B JR (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:B
Last Name:BYRUM
Suffix:JR
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:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-893-7462
Practice Address - Fax:502-212-7551
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1452384003OtherCIGNA / NMA
KYP00212765OtherRAILROAD MEDICARE
000052155KOtherHUMANA / NMA
KY64810039Medicaid
IN200107110Medicaid
1170395OtherPASSPORT / NMA
2440629000OtherPASSPORT ADVANTAGE / NMA
017043OtherSIHO / NMA
000000350638OtherANTHEM / NMA
11853OtherCHA / NMA
11853OtherCHA / NMA
KY64810039Medicaid