Provider Demographics
NPI:1942271606
Name:KOCAB, MARK ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:KOCAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:101 RIVERFRONT BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8823
Mailing Address - Country:US
Mailing Address - Phone:941-748-2417
Mailing Address - Fax:941-748-3694
Practice Address - Street 1:101 RIVERFRONT BLVD STE 700
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8823
Practice Address - Country:US
Practice Address - Phone:941-748-2417
Practice Address - Fax:941-748-3694
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0774610207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7485722003OtherCIGNA
FL02902OtherBCBS
2629306OtherAETNA HMO
2950007OtherUNITED HEALTHCARE
5083786OtherAETNA PPO
2950007OtherUNITED HEALTHCARE
H09745Medicare UPIN