Provider Demographics
NPI:1699715441
Name:KOKOCHAROV, STOYAN (MD)
Entity type:Individual
Prefix:DR
First Name:STOYAN
Middle Name:
Last Name:KOKOCHAROV
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 1:2500 W HIGGINS RD
Mailing Address - Street 2:SUITE 910
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7220
Mailing Address - Country:US
Mailing Address - Phone:224-412-2156
Mailing Address - Fax:847-648-4141
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:SUITE 910
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7220
Practice Address - Country:US
Practice Address - Phone:224-412-2156
Practice Address - Fax:847-648-4141
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085022208600000X
IL036122525208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
201608381OtherTRICARE
OH2530014Medicaid
OH000000353043OtherANTHEM BC BS
04676OtherPARAMOUNT
0007744642OtherAETNA
201608381OtherTRICARE
OH4151521Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID