Healthcare Provider Details

I. General information

NPI: 1023102084
Provider Name (Legal Business Name): CHRISTIAN E. KOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 ACKERMAN BLVD STE 110
KETTERING OH
45429-3559
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B3
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-5080
  • Fax: 937-293-8820
Mailing address:
  • Phone: 937-991-3191
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-075086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: