Provider Demographics
NPI:1104926492
Name:KOACH, KAREN (AP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KOACH
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SE 10TH AVE
Mailing Address - Street 2:#610
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2975
Mailing Address - Country:US
Mailing Address - Phone:954-760-7617
Mailing Address - Fax:954-760-4100
Practice Address - Street 1:3872 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-987-9929
Practice Address - Fax:954-987-7044
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP991171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist