Provider Demographics
NPI:1174572671
Name:KOKX, NICHOLAS P (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:P
Last Name:KOKX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4735 WEST RIVER DR.
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9607
Mailing Address - Country:US
Mailing Address - Phone:616-784-9400
Mailing Address - Fax:616-784-5167
Practice Address - Street 1:4735 WEST RIVER DR.
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:ID
Practice Address - Zip Code:49321-9607
Practice Address - Country:US
Practice Address - Phone:616-784-9400
Practice Address - Fax:616-784-5167
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039280208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2675237Medicaid
MI2675237Medicaid