Provider Demographics
NPI:1275618639
Name:KOVASH, CHAD (PA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:KOVASH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:10660 W 143RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1989
Mailing Address - Country:US
Mailing Address - Phone:708-349-0055
Mailing Address - Fax:708-460-8031
Practice Address - Street 1:1300 COPPERFIELD AVE STE 3070
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2065
Practice Address - Country:US
Practice Address - Phone:708-349-0055
Practice Address - Fax:708-460-8031
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL363862771363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK50297Medicare PIN