Provider Demographics
NPI:1447397468
Name:KOVACH, STEPHEN (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KOVACH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 DENMOOR CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8581
Mailing Address - Country:US
Mailing Address - Phone:614-440-3593
Mailing Address - Fax:614-944-5722
Practice Address - Street 1:466 N CASSADY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-1027
Practice Address - Country:US
Practice Address - Phone:614-440-3593
Practice Address - Fax:614-944-5722
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004985213ES0103X
OH36.003634213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004985Medicaid
ILL94860Medicare PIN
ILU80989Medicare UPIN