Healthcare Provider Details

I. General information

NPI: 1306953633
Provider Name (Legal Business Name): STANLEY PETER KOKOCKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 CHERRY ST STE 1250
TOLEDO OH
43608
US

IV. Provider business mailing address

2200 JEFFERSON AVE FL 5
TOLEDO OH
43604-7102
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-3180
  • Fax: 419-251-3849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME60880
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME60880
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036077018
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35133477
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: