Basic Information
| Provider Information | |||||||||
| NPI: | 1033186325 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TRETJAK | ||||||||
| FirstName: | ZIGA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9605 SANDIFUR PKWY | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993018028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099423627 | ||||||||
| FaxNumber: | 5095470827 | ||||||||
| Practice Location | |||||||||
| Address1: | 780 SWIFT BLVD, SUITE 270 | ||||||||
| Address2: | KADLEC CLINIC, GASTROENTEROLOGY | ||||||||
| City: | RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099423627 | ||||||||
| FaxNumber: | 5099433280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2006 | ||||||||
| LastUpdateDate: | 07/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 60113820 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0259824 | 01 | WA | LABOR & INDUSTRIES | OTHER | 0053CQ | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 8556128 | 05 | WA | MEDICAID | 113447001 | 05 | TX | MEDICAID |