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NPI Code Detail

MEDICARE: MARY ELIZABETH KOCH MD

MEDICARE: MARY ELIZABETH KOCH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician4301505606MI
2207P00000XEmergency Medicine Physician35.142827OH

General Provider Information

NPI Number : 1417453465
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH KOCH MD
Provider Business Mailing Address
First Line : 730 W MARKET ST
Second Line :
City : LIMA
State : OH
Zip : 45801-4667
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 730 W MARKET ST
Second Line :
City : LIMA
State : OH
Zip : 45801-4667
Country : US
Telephone Number : 419-227-3361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2018
Last Update Date : 10/11/2021

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Directions to “ MARY ELIZABETH KOCH MD” Practice Location

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