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General NPI Number Information
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NPI Number | 1073602116
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Entity Type | Individual
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Provider Name | ZDENEK A TUSEK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 4055 VALLEY VIEW LN
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City | DALLAS
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State | TX
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Zip | 75244-5074
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Country | US
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Telephone | 972-715-3800
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Fax | 888-705-9777
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Provider Business Mailing Address
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Address Line | 359 STETLER AVE
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City | SELINSGROVE
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State | PA
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Zip | 17870-9031
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Country | US
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Telephone | 570-743-8657
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 3694A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 16941
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License Number State | NE
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