Provider Demographics
NPI:1780627612
Name:BYRON, SCOTT EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:BYRON
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 1:11518 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2722
Mailing Address - Country:US
Mailing Address - Phone:810-632-7800
Mailing Address - Fax:810-632-7877
Practice Address - Street 1:11518 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2722
Practice Address - Country:US
Practice Address - Phone:810-632-7800
Practice Address - Fax:810-632-7877
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001901213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4854701270OtherBLUE CROSS/BLUE SHIELD
MI0P22720Medicare ID - Type Unspecified
MIU81832Medicare UPIN