Individual
BRETT ROBERT KOCKENTIET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
650 SHAWAN FALLS DR, DUBLIN, OH 43017-2100
(614) 764-1711
(614) 889-2652
Mailing address
650 SHAWAN FALLS DR, DUBLIN, OH 43017-2100
(614) 764-1711
(614) 889-2652
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
35.093291
OH
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
35.093291
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00744474
RR MEDICARE PIN
OH
01
—
1351
RR MEDICARE GRP ID
OH
Enumeration date
05/23/2007
Last updated
10/23/2024
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