Provider Demographics
NPI:1144223041
Name:KOCH, JANE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:4640 W LLOYD EXPY
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6517
Practice Address - Country:US
Practice Address - Phone:812-422-4336
Practice Address - Fax:812-421-0994
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000732A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480014795OtherTRAVELERS
IN000000042551OtherANTHEM PIN #
IN846030CMedicare PIN
IN480014795Medicare ID - Type UnspecifiedTRAVELERS MC PROVIDER #
IN846030CMedicare ID - Type Unspecified
IN0499720001Medicare NSC