Provider Demographics
NPI:1043435779
Name:KOVAS, TERESA ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ELLEN
Last Name:KOVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:ELLEN
Other - Last Name:VANDENBERGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:907 E TINKHAM AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1537
Practice Address - Country:US
Practice Address - Phone:231-843-3477
Practice Address - Fax:231-843-9042
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI528932080P0203X
MI4301099708208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine