Provider Demographics
NPI:1437258365
Name:COUCHOT, MICHAEL D (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:COUCHOT
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:D
Other - Last Name:COUCHOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MD
Mailing Address - Street 1:2844 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1917
Mailing Address - Country:US
Mailing Address - Phone:606-329-1115
Mailing Address - Fax:606-325-4639
Practice Address - Street 1:2844 CARTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1917
Practice Address - Country:US
Practice Address - Phone:606-329-1115
Practice Address - Fax:606-325-4639
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34851204E00000X
KY69891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60001054Medicaid
KY65935769Medicaid
KY61900452Medicaid
KY64033103Medicaid
KY61900452Medicaid
KY65935769Medicaid
KY60001054Medicaid