Barbra Byrd
Individual provider Active NPI Contractor · Walled Lake, MI
NPI 1073900239 · NPPES record last updated Apr 24, 2015
Key facts
- NPI
- 1073900239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 7501003604 (MI)
- Practice address
- 114 Lake Village Dr
Walled Lake, MI 48390-3635 - Phone
- (248) 408-8549
- NPI assigned
- Apr 24, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7501003604 | MI | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 7501003604 | MI | Yes |
Addresses
Primary practice location
114 Lake Village Dr
Walled Lake, MI 48390-3635
Mailing address
114 Lake Village Dr
Walled Lake, MI 48390-3635
Phone (248) 408-8549
Other providers in Walled Lake, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.