MEDICARE: NDIDIAMAKA KOKA M.D.

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	207Q00000X	Family Medicine Physician	42423	MN

General Provider Information

NPI Number	:	1518905405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NDIDIAMAKA KOKA M.D.

Provider Business Mailing Address
First Line	:	701 PARK AVE # SL350
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-1623
Country	:	US
Telephone Number	:	612-873-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 E LAKE ST STE 500
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-4385
Country	:	US
Telephone Number	:	612-873-6963
Fax Number	:	612-276-0188

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	02/24/2025

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