Provider Demographics
NPI:1679510622
Name:KOVAR, JOSEPH L (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:KOVAR
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 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN272372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN108075OtherUCARE
MN22846OtherAMERICA'S PPO
MN299G5KOOtherBLUE CROSS
WI300033557OtherRAILROAD MEDICARE WI
MN300077279OtherRAILROAD MEDICARE MN
WI30556400Medicaid
MN398075800Medicaid
MN9F152KOOtherBLUE CROSS
MNHP13731OtherHEALTHPARTNERS
MN0418001OtherPREFERRED ONE
MNHP13731OtherHEALTHPARTNERS
MN398075800Medicaid
WI001404070Medicare PIN
MN9F152KOOtherBLUE CROSS
MN300002988Medicare PIN