Provider Demographics
NPI:1215945209
Name:BYERS, MICHAEL R (PAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:BYERS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 MEDCOM ST
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-569-3367
Mailing Address - Fax:843-764-3577
Practice Address - Street 1:9100 MEDCOM ST
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-569-3367
Practice Address - Fax:843-764-3577
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC952207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3204Medicare PIN
Q17705Medicare UPIN