Provider Demographics
NPI:1518212224
Name:KENNETH G BERLINER MD PA
Entity Type:Organization
Organization Name:KENNETH G BERLINER MD PA
Other - Org Name:LONESTAR ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-936-5735
Mailing Address - Street 1:4710 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2204
Mailing Address - Country:US
Mailing Address - Phone:713-936-5735
Mailing Address - Fax:281-875-0316
Practice Address - Street 1:4710 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2204
Practice Address - Country:US
Practice Address - Phone:713-936-5735
Practice Address - Fax:281-875-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMK3682174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG58511Medicare UPIN