Provider Demographics
NPI:1497771927
Name:BERKENSTOCK, ORAN LEE (MD)
Entity Type:Individual
Prefix:
First Name:ORAN
Middle Name:LEE
Last Name:BERKENSTOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2044
Mailing Address - Street 2:DEPT 7800
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-2044
Mailing Address - Country:US
Mailing Address - Phone:901-761-6157
Mailing Address - Fax:901-761-4145
Practice Address - Street 1:6263 POPLAR AVE STE 1052
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4736
Practice Address - Country:US
Practice Address - Phone:901-761-6157
Practice Address - Fax:901-761-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24724207Q00000X
TNMD0000024724208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703214Medicaid
F64637Medicare UPIN
TN3079159Medicare ID - Type Unspecified