Provider Demographics
NPI:1497783443
Name:COCKERILL, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:COCKERILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 NAVARRE PL
Mailing Address - Street 2:SUITE 6600
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1156
Mailing Address - Country:US
Mailing Address - Phone:574-232-7227
Mailing Address - Fax:574-232-2064
Practice Address - Street 1:100 NAVARRE PL
Practice Address - Street 2:SUITE 6600
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1156
Practice Address - Country:US
Practice Address - Phone:574-232-7227
Practice Address - Fax:574-232-2064
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059005A174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200484210AMedicaid
ING66340Medicare UPIN
IN737820GMedicare ID - Type Unspecified