Provider Demographics
NPI:1548297898
Name:ZIDEK, KATHRYN A (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:ZIDEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4328
Mailing Address - Country:US
Mailing Address - Phone:281-218-8797
Mailing Address - Fax:281-286-7557
Practice Address - Street 1:655 E MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4328
Practice Address - Country:US
Practice Address - Phone:281-218-8797
Practice Address - Fax:281-286-7557
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8852208100000X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG45999Medicare UPIN
TX8A8053Medicare PIN