MEDICARE: DR. LISA S KOCHE 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	207R00000X	Internal Medicine Physician	ME0074302	FL

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	:	1811931207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA S KOCHE M.D.

Provider Business Mailing Address
First Line	:	5501 W GRAY ST STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1007
Country	:	US
Telephone Number	:	813-319-0911
Fax Number	:	813-319-0914

Provider Business Practice Location Address
First Line	:	5501 W GRAY ST STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1007
Country	:	US
Telephone Number	:	813-319-0911
Fax Number	:	813-319-0914

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/19/2024

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