Basic Information
Provider Information
NPI: 1629053061
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZIENTEK
FirstName: DAVID
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4616 W HOWARD LN
Address2:  
City: AUSTIN
State: TX
PostalCode: 787286300
CountryCode: US
TelephoneNumber: 5123248960
FaxNumber: 5123248906
Practice Location
Address1: 6811 AUSTIN CENTER BLVD
Address2: SUITE 410
City: AUSTIN
State: TX
PostalCode: 787313146
CountryCode: US
TelephoneNumber: 5123242705
FaxNumber: 5123242706
Other Information
ProviderEnumerationDate: 12/08/2005
LastUpdateDate: 10/28/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XJ1821TXN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011XJ1821TXY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

ID Information
IDTypeStateIssuerDescription
8CT02101TXBCBSOTHER
11913480705TX MEDICAID
32913480805TX MEDICAID
8ET55501TXBCBSOTHER
11913480505TX MEDICAID
11913480605TX MEDICAID
11913480805TX MEDICAID


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