Healthcare Provider Details

I. General information

NPI: 1083853006
Provider Name (Legal Business Name): RADOSLAW FILIP BIENIEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2009
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 HACKS CROSS RD
MEMPHIS TN
38125-8803
US

IV. Provider business mailing address

3495 HACKS CROSS RD
MEMPHIS TN
38125-8803
US

V. Phone/Fax

Practice location:
  • Phone: 901-526-7444
  • Fax:
Mailing address:
  • Phone: 901-526-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number44583
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number221105
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: