Provider Demographics
NPI:1457359549
Name:KOCH, KAREN SUE (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:KOCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-8931
Mailing Address - Country:US
Mailing Address - Phone:574-598-2020
Mailing Address - Fax:574-223-5847
Practice Address - Street 1:105 STATE ROAD 14 N
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:IN
Practice Address - Zip Code:46910-0219
Practice Address - Country:US
Practice Address - Phone:574-598-2020
Practice Address - Fax:574-223-5847
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002663A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200453670Medicaid
IN940970014Medicare PIN
INH94157Medicare UPIN
IN200453670Medicaid