Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
ETHAN BENJAMIN KOCH, MD
ActiveETHAN BENJAMIN KOCH, MD is a Vascular Surgery healthcare provider located in SAINT CLOUD, Minnesota. NPI 1023514007 is currently active in the NPPES registry. Verify at CMS.
Vascular Surgery · SAINT CLOUD, MN
Registration Details
- NPI Number
- 1023514007
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Mar 30, 2018 (8.3865292700554 yrs)
- Last Updated
- Apr 3, 2025
- Licenses
-
71757 (MN)71757 (MN)71757 (MN)
Practice Information
- Address
-
4801 VETERANS DRSAINT CLOUD, MN, 563032015Browse MN providers · Browse ZIP 56303
- Phone
- 3202521670
- Primary Specialty
-
Vascular Surgery
208VP0000X
- Additional Specialty
- General Practice
- Additional Specialty
- Vascular Surgery
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.