Provider Demographics
NPI:1922272517
Name:BOCI, MIRIAN (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAN
Middle Name:
Last Name:BOCI
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 1:8551 BLUEJACKET ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1656
Mailing Address - Country:US
Mailing Address - Phone:913-341-7985
Mailing Address - Fax:913-341-7988
Practice Address - Street 1:20375 W 151ST ST STE 409
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7210
Practice Address - Country:US
Practice Address - Phone:913-780-3388
Practice Address - Fax:913-780-3256
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013027007208800000X
KS04-36657208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSJ71000033Medicare PIN