Provider Demographics
NPI:1801874342
Name:KOKKILA, RICHARD LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEROY
Last Name:KOKKILA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1208 OLENA AVENUE SE
Mailing Address - Street 2:WILLMAR REGIONAL TREATMENT CENTER
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-9599
Mailing Address - Country:US
Mailing Address - Phone:320-235-0900
Mailing Address - Fax:320-214-3335
Practice Address - Street 1:1208 OLENA AVENUE SE
Practice Address - Street 2:MINNESOTA SPECIALTY HEALTH SYSTEM
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-9599
Practice Address - Country:US
Practice Address - Phone:320-235-0900
Practice Address - Fax:320-214-3335
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-10-31
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Provider Licenses
StateLicense IDTaxonomies
MN313052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN413287400Medicaid
MN269000117Medicare ID - Type Unspecified
MN413287400Medicaid