Doctor Name: | STEPHEN DARRYL PISHKO |
NPI Number: | 1073719944 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 1407 Union Ave Suite 200 Memphis, TN - 381043627 |
Business Phone Number: | 9018868813 |
Business Fax Number: | 9013022120 |
Mailing Address: | 1407 Union Ave, Suite 640 MEMPHIS |
State: | TN |
Postal Code: | 381043627 |
Phone Number: | 9018868373 |
Fax Number: | 9013022360 |
NPI Enumeration Date: | 06/26/2007 |
NPI Last Update Date: | 07/31/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |