Healthcare Provider Details

I. General information

NPI: 1326124223
Provider Name (Legal Business Name): JOHN KOCKA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 BRECKSVILLE RD
BRECKSVILLE OH
44141-2318
US

IV. Provider business mailing address

2830 FRANKLIN BLVD
CLEVELAND OH
44113-2978
US

V. Phone/Fax

Practice location:
  • Phone: 440-740-0696
  • Fax: 440-740-0697
Mailing address:
  • Phone: 330-425-4310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35082293K
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: