Provider Demographics
NPI:1104289909
Name:ZANETAKIS, MICHAEL W
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:ZANETAKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6529 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4145
Mailing Address - Country:US
Mailing Address - Phone:918-404-8210
Mailing Address - Fax:
Practice Address - Street 1:6529 E 85TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4145
Practice Address - Country:US
Practice Address - Phone:918-404-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator