Healthcare Provider Details

I. General information

NPI: 1548298375
Provider Name (Legal Business Name): PAUL KOCHERIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 KENSINGTON AVE
FLINT MI
48503-2044
US

IV. Provider business mailing address

302 KENSINGTON AVE
FLINT MI
48503-2044
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-8490
  • Fax:
Mailing address:
  • Phone: 810-762-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberPK066426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: