Basic Information
| Provider Information | |||||||||
| NPI: | 1447419668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOCH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 E 28TH ST # 11112 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554073723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128636590 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1925 WOODWINDS DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551254445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122320348 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 67003-21 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 70299 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 261731 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 56957 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.