MEDICARE: DR. JANE KOCH DPM

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	213E00000X	Podiatrist	07000732A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480014795	OTHER		TRAVELERS
2	000000042551	OTHER	IN	ANTHEM PIN #

General Provider Information

NPI Number	:	1144223041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE KOCH DPM

Provider Business Mailing Address
First Line	:	PO BOX 3276
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47731-3276
Country	:	US
Telephone Number	:	812-473-0181
Fax Number	:	812-473-5822

Provider Business Practice Location Address
First Line	:	4640 W LLOYD EXPY
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-6517
Country	:	US
Telephone Number	:	812-422-4336
Fax Number	:	812-421-0994

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/05/2020

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Directions to “ DR. JANE KOCH DPM” Practice Location

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