Provider Demographics
NPI:1386805679
Name:BYRNE, TERESA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:JEAN
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:JEAN
Other - Last Name:BURGEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:830 W HIGH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801
Mailing Address - Country:US
Mailing Address - Phone:419-222-4045
Mailing Address - Fax:419-228-5665
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:SUITE 102 AND SUITE 201
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801
Practice Address - Country:US
Practice Address - Phone:419-222-4045
Practice Address - Fax:419-228-5665
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092613208000000X
OH35.096729208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics