Individual
COLTON A. KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17550 K16 HWY, MCLOUTH, KS 66054
(913) 689-9650
Mailing address
17550 K16 HWY, MCLOUTH, KS 66054
(913) 689-9650
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
NONE
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XSB874710819
BLUECROSS BLUESHIELD OF KANSAS
KS
Enumeration date
11/27/2018
Last updated
11/27/2018
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