Provider Demographics
NPI:1396019766
Name:KOCH, MARKUS (LMP)
Entity Type:Individual
Prefix:MR
First Name:MARKUS
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21390 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9122
Mailing Address - Country:US
Mailing Address - Phone:734-660-0898
Mailing Address - Fax:866-816-1311
Practice Address - Street 1:21390 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:CHLESEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-660-0898
Practice Address - Fax:866-816-1311
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000733172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist