Individual
MR. MICHAEL DEAN COUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
159 TROUT AVE, GROTON, CT 06349-5159
(860) 581-0090
Mailing address
PO BOX 159, GROTON, CT 06349-5159
(860) 581-0090
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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