1780607200 NPI number — DR. MICHAEL EDWARD KOKAT D.P.M.

Table of content: DR. ROY R ANDERSON M.D. (NPI 1386668838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780607200 NPI number — DR. MICHAEL EDWARD KOKAT D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOKAT
Provider First Name:
MICHAEL
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780607200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 S MILWAUKEE AVENUE
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53105-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-763-9007
Provider Business Mailing Address Fax Number:
262-758-6134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 S MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53105-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-763-9007
Provider Business Practice Location Address Fax Number:
262-758-6134
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 924-025 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000054100 . This is a "MEDICARE, WPS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 43242100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com