Provider Demographics
NPI:1043425028
Name:KOCAK, ERGUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERGUN
Middle Name:
Last Name:KOCAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 CHERRY WAY DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6777
Mailing Address - Country:US
Mailing Address - Phone:855-687-6227
Mailing Address - Fax:855-687-6227
Practice Address - Street 1:1329 CHERRY WAY DR STE 700
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6799
Practice Address - Country:US
Practice Address - Phone:855-687-6227
Practice Address - Fax:855-687-6227
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350823342086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2954183Medicaid
OHH047940Medicare PIN