Provider Demographics
NPI:1568670149
Name:KOCH, SPENCER ROBISON (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:ROBISON
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE 6016
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-712-8350
Mailing Address - Fax:734-712-8351
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE 6016
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-8350
Practice Address - Fax:734-712-8351
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010864422085R0202X
NC1634662085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging