Healthcare Provider Details

I. General information

NPI: 1447222880
Provider Name (Legal Business Name): DEBENDRA N PATTANAIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE SUITE 200
MEMPHIS TN
38104-6638
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-525-0278
  • Fax: 901-526-9014
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number42945
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: