Provider Demographics
NPI:1356790091
Name:ZIATS, MARK NICHOLAS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:NICHOLAS
Last Name:ZIATS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 9TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3906
Mailing Address - Country:US
Mailing Address - Phone:817-332-3039
Mailing Address - Fax:
Practice Address - Street 1:1000 9TH AVE STE C
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3906
Practice Address - Country:US
Practice Address - Phone:817-332-3039
Practice Address - Fax:817-332-6902
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD52161207R00000X
SC52161208M00000X
MI4301109282390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program