Provider Demographics
NPI:1144229261
Name:COCHRAN, CALVIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:D
Last Name:COCHRAN
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 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-9712
Mailing Address - Country:US
Mailing Address - Phone:816-932-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:SUITE 65
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-932-6100
Practice Address - Fax:816-932-9002
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3K15207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100303970CMedicaid
MOP00381154OtherRAILROAD MEDICARE
MO203005020Medicaid
KS100303970AMedicaid
E83007Medicare UPIN
KS100303970AMedicaid
MOW192715Medicare PIN