Healthcare Provider Details

I. General information

NPI: 1922851245
Provider Name (Legal Business Name): LISA KOVTUN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 W DUNDEE RD
BUFFALO GROVE IL
60089-3758
US

IV. Provider business mailing address

56 W DUNDEE RD
BUFFALO GROVE IL
60089-3758
US

V. Phone/Fax

Practice location:
  • Phone: 224-601-5001
  • Fax:
Mailing address:
  • Phone: 224-601-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209029507
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: