Basic Information
| Provider Information | |||||||||
| NPI: | 1881622801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYRNE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 E WALL ST | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545219368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154773000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 324 N QUEEN ST | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285014932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525229800 | ||||||||
| FaxNumber: | 2525239790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 33365 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 200201056 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.