MEDICARE: BRYAN RENKEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	88285	SC

General Provider Information

NPI Number	:	1508219494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN RENKEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 117661
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-6306
Country	:	US
Telephone Number	:	704-749-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2536 LENGERS WAY
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-7126
Country	:	US
Telephone Number	:	704-749-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	03/08/2024

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