Provider Demographics
NPI:1033186325
Name:TRETJAK, ZIGA (MD)
Entity Type:Individual
Prefix:
First Name:ZIGA
Middle Name:
Last Name:TRETJAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 SANDIFUR PKWY
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8028
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-547-0827
Practice Address - Street 1:780 SWIFT BLVD, SUITE 270
Practice Address - Street 2:KADLEC CLINIC, GASTROENTEROLOGY
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-942-3627
Practice Address - Fax:509-943-3280
Is Sole Proprietor?:No
Enumeration Date:2006-03-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60113820207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0259824OtherLABOR & INDUSTRIES
TX0053CQOtherBLUE CROSS BLUE SHIELD
WA8556128Medicaid
TX113447001Medicaid
TXG32518Medicare UPIN
WA8889310Medicare PIN
TX00340DMedicare PIN