Provider Demographics
NPI:1669538013
Name:KOCHS ORTHOTIC AND PROSTHETICS
Entity type:Organization
Organization Name:KOCHS ORTHOTIC AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCELLO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRAO
Authorized Official - Suffix:
Authorized Official - Credentials:CO-PED
Authorized Official - Phone:734-723-5452
Mailing Address - Street 1:30021 GREENFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1524
Mailing Address - Country:US
Mailing Address - Phone:248-723-5452
Mailing Address - Fax:248-723-5495
Practice Address - Street 1:30021 GREENFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1524
Practice Address - Country:US
Practice Address - Phone:248-723-5452
Practice Address - Fax:248-723-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP43246OtherBLUE CARE NETWORK
MI100122OtherCARE CHOICES
MI100122OtherCARE CHOICES