Provider Demographics
NPI:1952359895
Name:SOVA, DAVID D (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:SOVA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4081 CASCADE RD SE
Mailing Address - Street 2:STE A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49456
Mailing Address - Country:US
Mailing Address - Phone:616-957-3500
Mailing Address - Fax:616-957-3501
Practice Address - Street 1:4081 CASCADE RD SE
Practice Address - Street 2:STE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49456
Practice Address - Country:US
Practice Address - Phone:616-957-3500
Practice Address - Fax:616-957-3501
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIDS009922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-4139770Medicaid
MIOM87390Medicare ID - Type Unspecified
MIF22773Medicare UPIN