Provider Demographics
NPI:1639325954
Name:KOCHERT PAIN INSTITUTE, LLC
Entity Type:Organization
Organization Name:KOCHERT PAIN INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOCHERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-446-5055
Mailing Address - Street 1:1345 UNITY PL
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5760
Mailing Address - Country:US
Mailing Address - Phone:765-446-5055
Mailing Address - Fax:765-446-5057
Practice Address - Street 1:1345 UNITY PL
Practice Address - Street 2:SUITE 225
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5760
Practice Address - Country:US
Practice Address - Phone:765-446-5055
Practice Address - Fax:765-446-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01031275A208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000585032OtherANTHEM PIN
IN000000585032OtherAPIN
IN258160Medicare PIN
IND07400Medicare PIN