Individual
BENJAMIN KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
2421 LAPORTE AVE, VALPARAISO, IN 46383-6914
(219) 462-6192
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71006049B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201345340
—
IN
Enumeration date
01/13/2016
Last updated
10/09/2023
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