Provider Demographics
NPI:1033462239
Name:KOVAC, JASON RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RONALD
Last Name:KOVAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13009 S PARKER RD UNIT 393
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3449
Mailing Address - Country:US
Mailing Address - Phone:720-666-4739
Mailing Address - Fax:
Practice Address - Street 1:11405 PENNSYLVANIA ST STE 104
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6905
Practice Address - Country:US
Practice Address - Phone:317-912-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036162908208800000X
MI4301508621208800000X
OH35.147072208800000X
IN01073892A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000876722OtherANTHEM
IN201227510Medicaid
IN201227510Medicaid
IN1487680518OtherGROUP NPI NUMBER
IN100194370OtherMEDICAID GROUP NUMBER
IN200288740OtherMEDICAID GROUP NUMBER
IN100194370OtherMEDICAID GROUP NUMBER