Healthcare Provider Details

I. General information

NPI: 1134519283
Provider Name (Legal Business Name): KOCHERT PAIN INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 DAUGHERTY DR SUITE 110
LAFAYETTE IN
47909-3997
US

IV. Provider business mailing address

3218 DAUGHERTY DR SUITE 110
LAFAYETTE IN
47909-3997
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 Code311Z00000X
TaxonomyCustodial Care Facility
License Number01031275A
License Number StateIN

VIII. Authorized Official

Name: CAROLYN KOCHERT
Title or Position: PHYSICIAN
Credential: MD
Phone: 765-446-5055