Provider Demographics
NPI:1518905405
Name:KOKA, NDIDIAMAKA (MD)
Entity Type:Individual
Prefix:
First Name:NDIDIAMAKA
Middle Name:
Last Name:KOKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 PARK AVE # SL350
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-9696
Mailing Address - Fax:612-630-8270
Practice Address - Street 1:2215 E LAKE ST STE 500
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-4385
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:612-276-0188
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN560080400Medicaid
MNH33129Medicare UPIN
MN560080400Medicaid