Healthcare Provider Details

I. General information

NPI: 1376519173
Provider Name (Legal Business Name): ALEX M COCCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 W ROYALE DR
MUNCIE IN
47304-2243
US

IV. Provider business mailing address

221 N CELIA AVE
MUNCIE IN
47303-4609
US

V. Phone/Fax

Practice location:
  • Phone: 765-284-7703
  • Fax: 765-284-6838
Mailing address:
  • Phone: 765-282-8905
  • Fax: 765-751-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01059700A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: