Provider Demographics
NPI:1992754493
Name:BOCKRATH, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BOCKRATH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1259 RICKERT DR
Mailing Address - Street 2:STE 200
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8904
Mailing Address - Country:US
Mailing Address - Phone:630-369-1572
Mailing Address - Fax:630-369-6139
Practice Address - Street 1:1259 RICKERT DR
Practice Address - Street 2:STE 200
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8904
Practice Address - Country:US
Practice Address - Phone:630-369-1572
Practice Address - Fax:630-369-6139
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036054923208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054923Medicaid
C37477Medicare UPIN
ILP00886Medicare ID - Type Unspecified