Provider Demographics
NPI:1104894260
Name:KOCH, ROBERT N (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:KOCH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:205 WABASHA ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1805
Mailing Address - Country:US
Mailing Address - Phone:651-293-8100
Mailing Address - Fax:651-293-8106
Practice Address - Street 1:205 S WABASHA ST
Practice Address - Street 2:HEALTHPARTNERS ST. PAUL CLINIC - MAIL STOP 31300A
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1805
Practice Address - Country:US
Practice Address - Phone:651-293-8100
Practice Address - Fax:651-293-8106
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-08-11
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Provider Licenses
StateLicense IDTaxonomies
MN31546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A95353Medicare UPIN