Provider Demographics
NPI:1932763125
Name:BYRNES, REBECCA J (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:BYRNES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 HANSEN CIR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7451
Mailing Address - Country:US
Mailing Address - Phone:231-292-3401
Mailing Address - Fax:
Practice Address - Street 1:4955 S M 88 HWY
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49615-9082
Practice Address - Country:US
Practice Address - Phone:231-533-8649
Practice Address - Fax:231-533-6778
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101026050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program