Provider Demographics
NPI:1144219577
Name:KOVALSKI, CHERYL DAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:DAWN
Last Name:KOVALSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 STABLER ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3022
Mailing Address - Country:US
Mailing Address - Phone:517-272-1950
Mailing Address - Fax:517-272-1961
Practice Address - Street 1:2901 STABLER ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3022
Practice Address - Country:US
Practice Address - Phone:517-272-1950
Practice Address - Fax:517-272-1961
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008717207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2606759-11Medicaid
MIM18910005Medicare ID - Type Unspecified
MI2606759-11Medicaid