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General NPI Number Information
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NPI Number | 1134519283
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Entity Type | Organization
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Legal Business Name | KOCHERT PAIN INSTITUTE LLC
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 3218 DAUGHERTY DR SUITE 110
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City | LAFAYETTE
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State | IN
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Zip | 47909-3997
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Country | US
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Telephone | 765-446-5055
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Fax | 765-446-5057
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Provider Business Mailing Address
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Address Line | 3218 DAUGHERTY DR SUITE 110
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City | LAFAYETTE
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State | IN
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Zip | 47909-3997
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Country | US
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Telephone | 765-446-5055
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Fax | 765-446-5057
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CAROLYN KOCHERT
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Credential | MD
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Telephone | 765-446-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 01031275A
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License Number State | IN
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