Provider Demographics
NPI:1225239098
Name:KOVAR, CARYN SUZANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:SUZANNE
Last Name:KOVAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:ENGADINE
Mailing Address - State:MI
Mailing Address - Zip Code:49827-0280
Mailing Address - Country:US
Mailing Address - Phone:906-477-6845
Mailing Address - Fax:
Practice Address - Street 1:1140 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1048
Practice Address - Country:US
Practice Address - Phone:906-643-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant