Provider Demographics
NPI:1881683803
Name:BERLINER, KENNETH GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GREGORY
Last Name:BERLINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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:281-875-3285
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3682207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG58511Medicare UPIN