Healthcare Provider Details

I. General information

NPI: 1437230596
Provider Name (Legal Business Name): THOMAS ZATOLOKIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 GLOCHESKI DR
MANISTEE MI
49660-0335
US

IV. Provider business mailing address

310 GLOCHESKI DR PO BOX 335
MANISTEE MI
49660-2639
US

V. Phone/Fax

Practice location:
  • Phone: 231-723-6516
  • Fax: 231-882-2195
Mailing address:
  • Phone: 231-723-6516
  • Fax: 231-882-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101010133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: