Provider Demographics
NPI:1376519173
Name:COCCO, ALEX M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:M
Last Name:COCCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:221 N CELIA AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4609
Mailing Address - Country:US
Mailing Address - Phone:765-282-8905
Mailing Address - Fax:765-751-1450
Practice Address - Street 1:1812 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2243
Practice Address - Country:US
Practice Address - Phone:765-284-7703
Practice Address - Fax:765-284-6838
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01059700A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200504320Medicaid
INP00915791OtherRR MEDICARE
INP00915791OtherRR MEDICARE
INM400028436Medicare PIN
IN200504320Medicaid