Provider Demographics
NPI:1891788220
Name:KOVESDI, JOHN M JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:KOVESDI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 MILAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-3106
Mailing Address - Country:US
Mailing Address - Phone:419-663-6464
Mailing Address - Fax:419-663-9881
Practice Address - Street 1:368 MILAN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-3106
Practice Address - Country:US
Practice Address - Phone:419-663-6464
Practice Address - Fax:419-663-9881
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3097207X00000X
OH340030972083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0448635Medicaid
A79795Medicare UPIN
OH0448635Medicaid