Healthcare Provider Details

I. General information

NPI: 1336169226
Provider Name (Legal Business Name): JOHN S. KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ABRAHAM FLEXNER WAY
LOUISVILLE KY
40202-1818
US

IV. Provider business mailing address

222 S 1ST ST SUITE 501
LOUISVILLE KY
40202-5404
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-2731
  • Fax: 502-583-2733
Mailing address:
  • Phone: 502-583-2731
  • Fax: 502-583-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34166
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: