1639168529 NPI number — JOHN M KOVAL M.D.

Table of content: JOHN M KOVAL M.D. (NPI 1639168529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639168529 NPI number — JOHN M KOVAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOVAL
Provider First Name:
JOHN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639168529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4031 UPPER CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUN CITY CENTER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33573-6819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-633-2733
Provider Business Mailing Address Fax Number:
813-642-0367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12206 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612-9211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-971-8276
Provider Business Practice Location Address Fax Number:
813-971-8277
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME37669 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 045208400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208700 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 30746 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 300126984 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 15211 . This is a "ALL FLORIDA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4129443 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 045208400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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