Individual
JOHN MICHAEL KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
(920) 272-1621
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 272-1621
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
46407
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34501700
—
WI
Enumeration date
07/14/2006
Last updated
07/28/2008
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