Provider Demographics
NPI:1740231588
Name:KOCH, KATHRYN L (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:L
Last Name:KOCH
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Gender:F
Credentials:NP
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:NEOPLASTIC DISEASES
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6800
Mailing Address - Fax:414-805-1514
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC HEMATOLOGY/ONCOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-456-4170
Practice Address - Fax:414-805-1514
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-10-01
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Provider Licenses
StateLicense IDTaxonomies
WI2213-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
009000261TOtherHUMANA
WI1740231588Medicaid
WI68086 1032Medicare PIN
P77664Medicare UPIN
WI1740231588Medicaid