MEDICARE: KIMBERLY MARIE KOCOUR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	2020019339	MO
2	208800000X	Urology Physician	04-51069	KS

General Provider Information

NPI Number	:	1306463773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MARIE KOCOUR MD

Provider Business Mailing Address
First Line	:	1133 COLLEGE AVE STE G100
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2756
Country	:	US
Telephone Number	:	785-537-8710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 COLLEGE AVE STE G100
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2756
Country	:	US
Telephone Number	:	785-537-8710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	06/24/2025

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