Provider Demographics
NPI:1841255809
Name:KOCIAN, BRADLEY E (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:E
Last Name:KOCIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY STE 420
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2850
Practice Address - Country:US
Practice Address - Phone:502-394-6200
Practice Address - Fax:502-394-6210
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36894207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1839771OtherCIGNA / NMA
KY64041445Medicaid
035903OtherSIHO / NMA
000052155HOtherHUMANA / NMA
1191695OtherCHA / NMA
2689211000OtherPASSPORT ADVANTAGE / NMA
50009782OtherPASSPORT / NMA
KYP00206866OtherRAILROAD MEDICARE / NMA
000000350662OtherANTHEM / NMA
035903OtherSIHO / NMA
KY0361935Medicare PIN