Individual
MRS. CONNIE ROSELLA KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA, CBIS
Contact information
Practice address
1490 E BELTLINE AVE SE, GRAND RAPIDS, MI 49506-4336
(616) 940-0040
(616) 940-8151
Mailing address
1490 E BELTLINE AVE SE, GRAND RAPIDS, MI 49506-4336
(616) 940-0040
(616) 940-8151
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1803
MI
Other
Enumeration date
06/09/2010
Last updated
06/09/2010
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