Provider Demographics
NPI:1104063155
Name:DAVID M. BYRENS, M.D., P.C.
Entity type:Organization
Organization Name:DAVID M. BYRENS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BYRENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-781-2111
Mailing Address - Street 1:215 E MANSION ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1167
Mailing Address - Country:US
Mailing Address - Phone:269-781-2111
Mailing Address - Fax:269-781-3181
Practice Address - Street 1:215 E MANSION ST STE 2F
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1167
Practice Address - Country:US
Practice Address - Phone:269-781-2111
Practice Address - Fax:269-781-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB048794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0131121OtherBLUE CROSS BLUE SHIELD MICHIGAN
MI4349267Medicaid
MI0131121OtherBLUE CROSS BLUE SHIELD MICHIGAN
MI0130053Medicare PIN