Provider Demographics
NPI:1558353458
Name:BYRNE, ANNETTA MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTA
Middle Name:MARGARET
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 77000
Mailing Address - Street 2:DEPARTMENT 771036
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2000
Mailing Address - Country:US
Mailing Address - Phone:586-477-4171
Mailing Address - Fax:586-447-4180
Practice Address - Street 1:22480 KELLY RD
Practice Address - Street 2:SUITE A
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2623
Practice Address - Country:US
Practice Address - Phone:586-771-1211
Practice Address - Fax:586-771-2189
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301055337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3237220Medicaid
G21965Medicare UPIN
MIM75620044Medicare ID - Type Unspecified