Provider Demographics
NPI:1801915350
Name:KOVACHEVICH, RUDY (MD)
Entity type:Individual
Prefix:MR
First Name:RUDY
Middle Name:
Last Name:KOVACHEVICH
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 1:601 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3781
Mailing Address - Country:US
Mailing Address - Phone:303-744-7078
Mailing Address - Fax:303-744-0248
Practice Address - Street 1:601 E HAMPDEN AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-744-7078
Practice Address - Fax:303-744-0248
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49777207X00000X
IN01069735A207X00000X
CODR51415207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400049317Medicare PIN
MN200002634Medicare PIN