Provider Demographics
NPI:1811931207
Name:KOCHE, LISA S (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:S
Last Name:KOCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5501 W GRAY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1007
Mailing Address - Country:US
Mailing Address - Phone:813-319-0911
Mailing Address - Fax:813-319-0914
Practice Address - Street 1:5501 W GRAY ST STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1007
Practice Address - Country:US
Practice Address - Phone:813-319-0911
Practice Address - Fax:813-319-0914
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0074302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256120400Medicaid
H02786Medicare UPIN
FL256120400Medicaid