Healthcare Provider Details

I. General information

NPI: 1952006439
Provider Name (Legal Business Name): AIDAN KOCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5492 N RONALD REAGAN PARKWAY SUITE 2105
BROWNSBURG IN
46112-5618
US

IV. Provider business mailing address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-3851
  • Fax: 317-852-1246
Mailing address:
  • Phone: 317-837-5566
  • Fax: 317-718-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02008659A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: