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General NPI Number Information
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NPI Number | 1487623286
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Entity Type | Individual
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Provider Name | PAUL W. KOCH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 11/27/2022
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Provider Practice Location Address
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Address Line | 159 KERCHEVAL AVE.
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City | GROSSE POINTE
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State | MI
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Zip | 48236
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Country | US
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Telephone | 313-640-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 24920 FAIRMOUNT DR
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City | DEARBORN
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State | MI
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Zip | 48124-1584
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Country | US
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Telephone | 313-274-6579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 4301052069
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036110592
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036110592
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License Number State | IL
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