Provider Demographics
NPI:1174668933
Name:KOCSIS, IMRE J (DO)
Entity Type:Individual
Prefix:DR
First Name:IMRE
Middle Name:J
Last Name:KOCSIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4798 HIGHWAY 377
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76116-8892
Mailing Address - Country:US
Mailing Address - Phone:817-244-9500
Mailing Address - Fax:817-244-9502
Practice Address - Street 1:4798 HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76116-8892
Practice Address - Country:US
Practice Address - Phone:817-244-9500
Practice Address - Fax:817-244-9502
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXE9747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004HAOtherBLUE CROSS
TX139948723Medicaid
TXTXB148303OtherMEDICARE INDIVIDUAL #
TX139948724Medicaid
TX139948725Medicaid
TX74045OtherAMERIGROUP
TXTXB148304OtherMEDICARE GROUP #
TX00764QMedicare ID - Type Unspecified
TX139948723Medicaid