MEDICARE: CAROLYN G KOCHERT 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	207L00000X	Anesthesiology Physician	01031275A	IN
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	01031275A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000585033	OTHER	IN	ANTHEM PIN
2	11559907	OTHER	IN	CAQH
3	000000585033	OTHER	IN	APIN

General Provider Information

NPI Number	:	1306815915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN G KOCHERT MD

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 DRIVE
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	12/23/2011

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Directions to “ CAROLYN G KOCHERT MD” Practice Location

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