Provider Demographics
NPI:1306815915
Name:KOCHERT, CAROLYN G (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:G
Last Name:KOCHERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 DAUGHERTY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-3997
Mailing Address - Country:US
Mailing Address - Phone:765-446-5055
Mailing Address - Fax:765-446-5057
Practice Address - Street 1:3218 DAUGHERTY DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-3997
Practice Address - Country:US
Practice Address - Phone:765-446-5055
Practice Address - Fax:765-446-5057
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031275A207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000585033OtherANTHEM PIN
IN11559907OtherCAQH
IN000000585033OtherAPIN
IN000000585033OtherAPIN
IN11559907OtherCAQH