Provider Demographics
NPI:1619082872
Name:ZATKALIK, SHANE EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:EDWARD
Last Name:ZATKALIK
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 1:8160 WALNUT HILL LANE, SUITE 8160
Mailing Address - Street 2:PRESBYTERIAN HOSPITAL OF DALLAS, PEROT BLDG
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-345-4733
Mailing Address - Fax:214-345-7963
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8185
Practice Address - Country:US
Practice Address - Phone:972-981-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5630207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058QROtherBCBS
TX164760407Medicaid
TX0058QROtherBCBS
I04685Medicare UPIN