MEDICARE: H. BRUCE KOCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	35058963	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043235286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	H. BRUCE KOCH MD

Provider Business Mailing Address
First Line	:	1984 WOODBINE CT
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-9277
Country	:	US
Telephone Number	:	937-335-2122
Fax Number	:	937-498-4201

Provider Business Practice Location Address
First Line	:	915 W MICHIGAN
Second Line	:	WILSON MEMORIAL HOSPITAL EMERGENCY DEPT.
City	:	SIDNEY
State	:	OH
Zip	:	45365-2491
Country	:	US
Telephone Number	:	937-498-5300
Fax Number	:	937-498-4201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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