Provider Demographics
NPI:1871559369
Name:KOKSAL, THOMAS L (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:KOKSAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:911 N MAIN STREET
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-1133
Mailing Address - Country:US
Mailing Address - Phone:620-276-8201
Mailing Address - Fax:620-275-0712
Practice Address - Street 1:911 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5400
Practice Address - Country:US
Practice Address - Phone:620-276-8201
Practice Address - Fax:620-275-0712
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2010-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-17269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100088530BMedicaid
KS100088530BMedicaid
KSB91263Medicare UPIN