Individual
PAUL W. KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
159 KERCHEVAL AVE., GROSSE POINTE, MI 48236
(313) 640-2300
Mailing address
24920 FAIRMOUNT DR, DEARBORN, MI 48124-1584
(313) 274-6579
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036110592
IL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
4301052069
MI
207R00000X
Internal Medicine Physician
036110592
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110592-2
—
IL
01
—
3932056
BLUE SHEILD
IL
Enumeration date
03/15/2006
Last updated
11/27/2022
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