Healthcare Provider Details

I. General information

NPI: 1518607654
Provider Name (Legal Business Name): MATTHEW ALLEN KOCHHEISER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 S TRIMBLE RD
MANSFIELD OH
44906-3418
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 419-524-1410
  • Fax: 419-524-2202
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.017937
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: