Provider Demographics
NPI:1386643658
Name:KOVACH, KEVIN J (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:KOVACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2821
Mailing Address - Country:US
Mailing Address - Phone:630-833-9621
Mailing Address - Fax:630-833-9465
Practice Address - Street 1:152 N ADDISON AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-833-9621
Practice Address - Fax:630-833-9465
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2018-05-17
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IL036090975207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180037523OtherRAILROAD PALMETTO GBA
IL4132670001Medicare NSC
IL180037523OtherRAILROAD PALMETTO GBA
ILG23234Medicare UPIN