Provider Demographics
NPI:1114160249
Name:KOVALA, CHAD MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MICHAEL
Last Name:KOVALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17717 MASONIC
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-3158
Mailing Address - Country:US
Mailing Address - Phone:586-294-0600
Mailing Address - Fax:586-294-2525
Practice Address - Street 1:17717 MASONIC
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3158
Practice Address - Country:US
Practice Address - Phone:586-294-0600
Practice Address - Fax:586-294-2525
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007123A207P00000X
MI5101018084207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine