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NPI Code Detail

MEDICARE: JOHN M KOVAL M.D.

MEDICARE: JOHN M KOVAL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistME37669FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4300126984OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2208700OTHERFLAVMED
330746OTHERFLBLUE CROSS BLUE SHIELD
515211OTHERFLALL FLORIDA PPO
64129443OTHERFLAETNA
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639168529
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN M KOVAL M.D.
Provider Business Mailing Address
First Line : 4031 UPPER CREEK DR
Second Line :
City : SUN CITY CENTER
State : FL
Zip : 33573-6819
Country : US
Telephone Number : 813-633-2733
Fax Number : 813-642-0367
Provider Business Practice Location Address
First Line : 12206 BRUCE B DOWNS BLVD
Second Line : STE 101
City : TAMPA
State : FL
Zip : 33612-9211
Country : US
Telephone Number : 813-971-8276
Fax Number : 813-971-8277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 08/05/2010

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