Provider Demographics
NPI:1396134243
Name:KOVACH, CHRISTOPHER P (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:P
Last Name:KOVACH
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 1:1625 MEDICAL CENTER PT STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5748
Mailing Address - Country:US
Mailing Address - Phone:719-960-0363
Mailing Address - Fax:
Practice Address - Street 1:1625 MEDICAL CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8731
Practice Address - Country:US
Practice Address - Phone:719-960-0363
Practice Address - Fax:719-413-0363
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60748520207R00000X
CODR.0072207207R00000X, 207RC0000X, 207RI0011X
RIMD19100207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1396134243Medicaid
CODR.0072207OtherMEDICAL LICENSE
CO1396134243Medicaid
RIMD19100OtherMEDICAL LICENSE