Organization
KOCH FAMILY MEDICINE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY KOCH M.D. (PHYSICIAN)
(309) 263-2411
Entity
Organization
Contact information
Practice address
411 MAXINE DR, MORTON, IL 61550-2495
(309) 263-2411
Mailing address
411 MAXINE DR, MORTON, IL 61550-2495
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036060959
—
IL
01
—
1467436436
INDIVIDUAL NPI NUMBER
IL
Enumeration date
04/04/2007
Last updated
10/20/2010
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