Healthcare Provider Details

I. General information

NPI: 1073719944
Provider Name (Legal Business Name): STEPHEN DARRYL PISHKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 UNION AVE SUITE 200
MEMPHIS TN
38104-3627
US

IV. Provider business mailing address

1407 UNION AVE SUITE 640
MEMPHIS TN
38104-3627
US

V. Phone/Fax

Practice location:
  • Phone: 901-886-8813
  • Fax: 901-302-2120
Mailing address:
  • Phone: 901-886-8373
  • Fax: 901-302-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45121
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number45121
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: