Provider Demographics
NPI:1053364265
Name:HOCKSTAD, ERIC S (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:HOCKSTAD
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 1:4000 CAMBRIDGE ST STE G600
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8501
Mailing Address - Country:US
Mailing Address - Phone:913-588-9600
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE STREET
Practice Address - Street 2:SUITE G600
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8501
Practice Address - Country:US
Practice Address - Phone:913-588-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110276207RI0011X
KS0426647207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO038A00017OtherMEDICARE
MO038E00028OtherMEDICARE
KS110330031OtherMEDICARE
431092652 A018OtherCHAMPUS TRICARE
0005658218OtherAETNA PPO
MO1053364265Medicaid
KS201111290AMedicaid
0005658218OtherAETNA
KS038B00037OtherMEDICARE
23450018OtherBLUE SHIELD OF KC HMO
0005658218OtherAETNA HMO
060036604OtherMEDICARE RAILROAD
23450018OtherPHP FREEDOM
23450018OtherBLUE SHIELD OF KC PPO
MOP00853600OtherMEDICARE RAILROAD
0005658218OtherAETNA
MO1053364265Medicaid