Provider Demographics
NPI:1174591150
Name:BYRNE, HARRY T (DPM)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:T
Last Name:BYRNE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BRETT CHASE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5706
Mailing Address - Country:US
Mailing Address - Phone:800-467-2392
Mailing Address - Fax:812-471-6650
Practice Address - Street 1:120 BRETT CHASE
Practice Address - Street 2:SUITE C
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5706
Practice Address - Country:US
Practice Address - Phone:888-839-1382
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00192213E00000X
IL205410213E00000X
MO213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80001928Medicaid
U09973Medicare UPIN
KY2009601Medicare ID - Type Unspecified
KY80001928Medicaid