Healthcare Provider Details

I. General information

NPI: 1780248971
Provider Name (Legal Business Name): CARYNN E KOCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 350
INDIANAPOLIS IN
46237-8634
US

IV. Provider business mailing address

6983 HILLSDALE CT
INDIANAPOLIS IN
46250-2054
US

V. Phone/Fax

Practice location:
  • Phone: 317-308-2800
  • Fax: 317-859-4040
Mailing address:
  • Phone: 317-308-2800
  • Fax: 317-576-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01099511A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: