Healthcare Provider Details

I. General information

NPI: 1639325954
Provider Name (Legal Business Name): KOCHERT PAIN INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 UNITY PL SUITE 225
LAFAYETTE IN
47905-5760
US

IV. Provider business mailing address

1345 UNITY PL SUITE 225
LAFAYETTE IN
47905-5760
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-5055
  • Fax: 765-446-5057
Mailing address:
  • Phone: 765-446-5055
  • Fax: 765-446-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberIN01031275A
License Number StateIN

VIII. Authorized Official

Name: DR. CAROLYN G. KOCHERT
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 765-446-5055