Healthcare Provider Details

I. General information

NPI: 1801162904
Provider Name (Legal Business Name): THOMAS ANTONIOS ZIKOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 11/29/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR GRANT S101
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR GRANT S101
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-6661
  • Fax: 650-498-6205
Mailing address:
  • Phone: 650-723-6661
  • Fax: 650-498-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA126604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: