MEDICARE: JOHN KOUCH M.D.

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	207Q00000X	Family Medicine Physician	051363	CT

General Provider Information

NPI Number	:	1801024476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KOUCH M.D.

Provider Business Mailing Address
First Line	:	263 FARMINGTON AVE
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06030-8082
Country	:	US
Telephone Number	:	860-658-3444
Fax Number	:	860-658-3458

Provider Business Practice Location Address
First Line	:	117 ALBANY TPKE
Second Line	:
City	:	CANTON
State	:	CT
Zip	:	06019-2507
Country	:	US
Telephone Number	:	860-658-3444
Fax Number	:	860-658-3458

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

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	07/30/2024

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