MEDICARE: ORAN LEE BERKENSTOCK MD

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	207Q00000X	Family Medicine Physician	MD24724	TN
2	208M00000X	Hospitalist Physician	MD0000024724	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497771927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORAN LEE BERKENSTOCK MD

Provider Business Mailing Address
First Line	:	PO BOX 2044
Second Line	:	DEPT 7800
City	:	MEMPHIS
State	:	TN
Zip	:	38101-2044
Country	:	US
Telephone Number	:	901-761-6157
Fax Number	:	901-761-4145

Provider Business Practice Location Address
First Line	:	6263 POPLAR AVE STE 1052
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4736
Country	:	US
Telephone Number	:	901-761-6157
Fax Number	:	901-761-4145

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	03/17/2018

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