Provider Demographics
NPI:1326124223
Name:KOCKA, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KOCKA
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 1:2830 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2978
Mailing Address - Country:US
Mailing Address - Phone:330-425-4310
Mailing Address - Fax:
Practice Address - Street 1:8930 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2318
Practice Address - Country:US
Practice Address - Phone:440-740-0696
Practice Address - Fax:440-740-0697
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082293K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2427216Medicaid
OHH96297Medicare UPIN
OH2427216Medicaid
OHH035966Medicare PIN