Provider Demographics
NPI:1588765689
Name:MCCOY-MINOCHA, MIKKI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MIKKI
Middle Name:LYNN
Last Name:MCCOY-MINOCHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2157
Mailing Address - Country:US
Mailing Address - Phone:785-539-0800
Mailing Address - Fax:785-539-0811
Practice Address - Street 1:3260 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-2157
Practice Address - Country:US
Practice Address - Phone:785-539-0800
Practice Address - Fax:785-539-0811
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0426426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100315150BMedicaid
KSG78544Medicare UPIN
KS054311Medicare ID - Type Unspecified
KS100315150BMedicaid