Provider Demographics
NPI:1437230596
Name:ZATOLOKIN, THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ZATOLOKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 GLOCHESKI DR
Mailing Address - Street 2:PO BOX 335
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2639
Mailing Address - Country:US
Mailing Address - Phone:231-723-6516
Mailing Address - Fax:231-882-2195
Practice Address - Street 1:310 GLOCHESKI DR
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-0335
Practice Address - Country:US
Practice Address - Phone:231-723-6516
Practice Address - Fax:231-882-2195
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010101332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101010133OtherSTATE LICENSE NUMBER
MI5101010133OtherCONTROLLED SUBSTANCE LICE
MI3067667Medicaid
MIBZ1666809OtherDEA #
MIEO16001013Medicare ID - Type UnspecifiedMEDICARE ID #