Provider Demographics
NPI:1780777094
Name:KOVITZ, KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:KOVITZ
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 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-981-3660
Mailing Address - Fax:847-956-5108
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 510
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3660
Practice Address - Fax:847-956-5108
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1780777094207RC0200X
IL1780777094207RP1001X
LA10036R207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116995Medicaid
IL1617373OtherBCBS OF IL
IL036116995Medicaid
IL036116995Medicaid
ILR03731Medicare PIN
ILP00385566Medicare PIN
IL1617373OtherBCBS OF IL
LA5R835Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER