Healthcare Provider Details

I. General information

NPI: 1619082872
Provider Name (Legal Business Name): SHANE EDWARD ZATKALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W PARKER RD
PLANO TX
75093-8185
US

IV. Provider business mailing address

8160 WALNUT HILL LANE, SUITE 8160 PRESBYTERIAN HOSPITAL OF DALLAS, PEROT BLDG
DALLAS TX
75231
US

V. Phone/Fax

Practice location:
  • Phone: 972-981-8008
  • Fax:
Mailing address:
  • Phone: 214-345-4733
  • Fax: 214-345-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL5630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: