Individual
MRS. ELIZABETH ALICE KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085003308
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085003308
—
IL
01
—
1003856758
MEDICARE DUPAGE COUNTY
IL
01
—
1770524670
MEDICARE ID- COOK CO
IL
Enumeration date
10/03/2008
Last updated
02/01/2017
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