Provider Demographics
NPI:1821084252
Name:KOCH, MICHAEL O (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:535 BARNHILL DR
Mailing Address - Street 2:RT 420
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:317-944-7338
Mailing Address - Fax:317-278-0499
Practice Address - Street 1:535 BARNHILL DR
Practice Address - Street 2:RT 420
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-944-7338
Practice Address - Fax:317-278-0499
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-01-13
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Provider Licenses
StateLicense IDTaxonomies
IN01048495A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200110150Medicaid
IN200110150Medicaid
IN340015649Medicare PIN
IN064740UMedicare PIN