Individual
TIMOTHY C KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
Mailing address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
43215-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43492500
—
WI
01
—
930105103
MEDICARE RAILROAD
WI
Enumeration date
06/30/2006
Last updated
03/25/2019
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