Provider Demographics
NPI:1841286820
Name:KOCH, CAROLINE M (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:M
Last Name:KOCH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3707 N STOCKTON HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0507
Mailing Address - Country:US
Mailing Address - Phone:928-757-8111
Mailing Address - Fax:928-757-3256
Practice Address - Street 1:2187 SWANSON AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6838
Practice Address - Country:US
Practice Address - Phone:928-855-3432
Practice Address - Fax:928-757-3256
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-09-12
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Provider Licenses
StateLicense IDTaxonomies
AZ176052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ277691Medicaid
Z26WCHMFD3Medicare ID - Type Unspecified