Provider Demographics
NPI:1861501082
Name:KOVANDA, CHRISTOPHER J (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:KOVANDA
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 UPLAND LN N STE 205
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4474
Mailing Address - Country:US
Mailing Address - Phone:763-416-0676
Mailing Address - Fax:763-416-0476
Practice Address - Street 1:4999 FRANCE AVE S STE 210
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55410-2168
Practice Address - Country:US
Practice Address - Phone:612-335-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41657208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32594400Medicaid
MN240006520OtherRAILROAD MEDICARE
MN40B11KOOtherBLUE CROSS BLUE SHIELD
MN852226000Medicaid
MN1312285OtherMEDICA
MN41657OtherMINNESOTA LICENSE
MNHP28575OtherHEALTHPARTNERS
MN1300021OtherMEDICA PRIMARY
MN123451OtherUCARE
MN960011020119OtherPREFERREDONE
MN1312285OtherMEDICA
MNG99072Medicare UPIN