MEDICARE: AIDAN KOCH DO

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
1	207Q00000X	Family Medicine Physician	02008659A	IN

General Provider Information

NPI Number	:	1952006439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIDAN KOCH DO

Provider Business Mailing Address
First Line	:	1000 E MAIN ST
Second Line	:
City	:	DANVILLE
State	:	IN
Zip	:	46122-1948
Country	:	US
Telephone Number	:	317-837-5566
Fax Number	:	317-718-6793

Provider Business Practice Location Address
First Line	:	5492 N RONALD REAGAN PARKWAY
Second Line	:	SUITE 2105
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-5618
Country	:	US
Telephone Number	:	317-852-3851
Fax Number	:	317-852-1246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	06/02/2026

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