Provider Demographics
NPI:1902874126
Name:BYRENS, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:BYRENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Practice Address - Country:US
Practice Address - Phone:269-781-2111
Practice Address - Fax:269-781-3181
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB048794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0130434OtherPHYSICIANS HEALTH PLAN
MI4349267Medicaid
MI0131121OtherBLUE CARE NETWORK
MI1104063155OtherORGANIZATION NPI
MI0801311211OtherBCBSM
MIMI2669Medicare PIN
MI0131121OtherBLUE CARE NETWORK
MI0130053Medicare ID - Type Unspecified