Basic Information
Provider Information
NPI: 1245296151
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BYERLY
FirstName: AMY
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 776351
Address2:  
City: CHICAGO
State: IL
PostalCode: 606776351
CountryCode: US
TelephoneNumber: 5025889490
FaxNumber: 5022725116
Practice Location
Address1: 4420 DIXIE HWY STE 114
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402162986
CountryCode: US
TelephoneNumber: 5024496464
FaxNumber: 5024496465
Other Information
ProviderEnumerationDate: 04/21/2006
LastUpdateDate: 10/31/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X32118KYY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
000023036I01KYHUMANA- NORTON MEDICAL ASSOCIATESOTHER
6432118505KY MEDICAID
914257401KYCIGNA- NMAOTHER
P0089304101KYRAILROAD MEDICARE- NMAOTHER
10422201KYSIHO- NORTON MEDICAL ASSOCIATESOTHER
00000035052201KYANTHEM- NORTON MEDICAL ASSOCIATESOTHER
5002387101KYPASSPORT- NMAOTHER
371326800001KYPASSPORT ADVANTAGE- NMAOTHER
0053312801KYMEDICARE- NORTON MEDICAL ASSOCIATESOTHER
0053312801KYMEDICARE KY- NORTON MEDICAL ASSOCIATESOTHER


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