Individual
MICHAEL STEPHEN KOCH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
102 W KENWOOD AVE, DECATUR, IL 62526-4300
(217) 876-6820
Mailing address
3137 COLORADO DR, DECATUR, IL 62526-2332
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
96002099
IL
Other
Enumeration date
02/27/2006
Last updated
07/08/2007
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