Provider Demographics
NPI:1437390788
Name:KOVALCHUK, OLEKSANDR IVANOVYCH (MD)
Entity Type:Individual
Prefix:
First Name:OLEKSANDR
Middle Name:IVANOVYCH
Last Name:KOVALCHUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OLEKSANDR
Other - Middle Name:
Other - Last Name:KOVALCHUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2980 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0421
Mailing Address - Country:US
Mailing Address - Phone:352-622-4231
Mailing Address - Fax:352-622-0513
Practice Address - Street 1:2980 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0421
Practice Address - Country:US
Practice Address - Phone:352-622-4231
Practice Address - Fax:352-622-0513
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103932207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology