MEDICARE: KOCHERT PAIN INSTITUTE LLC

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	311Z00000X	Custodial Care Facility	01031275A	IN

General Provider Information

NPI Number	:	1134519283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOCHERT PAIN INSTITUTE LLC

Provider Business Mailing Address
First Line	:	3218 DAUGHERTY DR
Second Line	:	SUITE 110
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-3997
Country	:	US
Telephone Number	:	765-446-5055
Fax Number	:	765-446-5057

Provider Business Practice Location Address
First Line	:	3218 DAUGHERTY DR
Second Line	:	SUITE 110
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-3997
Country	:	US
Telephone Number	:	765-446-5055
Fax Number	:	765-446-5057

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	CAROLYN KOCHERT
Credential	:	MD
Telephone Number	:	765-446-5055

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	01/28/2015

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Directions to “KOCHERT PAIN INSTITUTE LLC ” Practice Location

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