Provider Demographics
NPI:1548590482
Name:KOCH, SUSAN HATFIELD (SUSAN KOCH MD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HATFIELD
Last Name:KOCH
Suffix:
Gender:F
Credentials:SUSAN KOCH MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 FRONTAGE RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3034
Mailing Address - Country:US
Mailing Address - Phone:847-707-2600
Mailing Address - Fax:
Practice Address - Street 1:456 FRONTAGE RD
Practice Address - Street 2:SUITE 28
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3034
Practice Address - Country:US
Practice Address - Phone:847-707-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-27
Last Update Date:2009-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3360523602084P0800X
IL0360907472084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry