MEDICARE: DR. KENNETH ANDREW BERUMEN 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	207P00000X	Emergency Medicine Physician	K8878	TX

General Provider Information

NPI Number	:	1588661243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ANDREW BERUMEN M.D.

Provider Business Mailing Address
First Line	:	6112 LAGUNA VISTA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-4104
Country	:	US
Telephone Number	:	915-241-1435
Fax Number	:	915-877-4895

Provider Business Practice Location Address
First Line	:	1625 MEDICAL CENTER DR
Second Line	:	C/O EMERGENCY DEPT.
City	:	EL PASO
State	:	TX
Zip	:	79902-5005
Country	:	US
Telephone Number	:	915-747-2660
Fax Number	:	915-747-2880

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/26/2016

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