Provider Demographics
NPI:1285197814
Name:TKACH, SHAUN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:DAVID
Last Name:TKACH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:800 STANTON L YOUNG BLVD # 3400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5018
Mailing Address - Country:US
Mailing Address - Phone:405-271-5964
Mailing Address - Fax:405-271-3461
Practice Address - Street 1:711 STANTON L YOUNG BLVD STE 111
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5021
Practice Address - Country:US
Practice Address - Phone:405-271-4906
Practice Address - Fax:405-271-4910
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK34829207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery