MEDICARE: DR. CHRISTOPHER J KOVANDA MEDICAL DOCTOR

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
1	208200000X	Plastic Surgery Physician	41657	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	240006520	OTHER	MN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	40B11KO	OTHER	MN	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1312285	OTHER	MN	MEDICA
6	41657	OTHER	MN	MINNESOTA LICENSE
7	HP28575	OTHER	MN	HEALTHPARTNERS
8	1300021	OTHER	MN	MEDICA PRIMARY
9	123451	OTHER	MN	UCARE
10	960011020119	OTHER	MN	PREFERREDONE

General Provider Information

NPI Number	:	1861501082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER J KOVANDA MEDICAL DOCTOR

Provider Business Mailing Address
First Line	:	9325 UPLAND LN N STE 205
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-4474
Country	:	US
Telephone Number	:	763-416-0676
Fax Number	:	763-416-0476

Provider Business Practice Location Address
First Line	:	4999 FRANCE AVE S STE 210
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55410-2168
Country	:	US
Telephone Number	:	612-335-9032
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/10/2019

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Directions to “ DR. CHRISTOPHER J KOVANDA MEDICAL DOCTOR” Practice Location

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