Individual
MARK KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3000 MACK RD, FAIRFIELD, OH 45014-5335
(513) 870-7000
Mailing address
11490 SPRINGFIELD PIKE, CINCINNATI, OH 45246-3524
(513) 672-3309
(513) 672-3323
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
172619
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0765435
—
OH
Enumeration date
08/24/2005
Last updated
03/26/2008
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