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:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 80TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-9259
Mailing Address - Country:US
Mailing Address - Phone:941-713-9246
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE M-302
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5357
Practice Address - Country:US
Practice Address - Phone:269-349-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74150207RG0100X
MT143712207RG0100X
MI4301512571207RG0100X
FLME0774610207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2629306OtherAETNA HMO
FL02902OtherBCBS
2950007OtherUNITED HEALTHCARE
5083786OtherAETNA PPO
7485722003OtherCIGNA
2950007OtherUNITED HEALTHCARE
H09745Medicare UPIN