Healthcare Provider Details

I. General information

NPI: 1780641852
Provider Name (Legal Business Name): MICHAEL A COVLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 OFFICE PARK DR
MARION IL
62959-6477
US

IV. Provider business mailing address

3408 OFFICE PARK DR
MARION IL
62959-6477
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5266
  • Fax: 618-997-5285
Mailing address:
  • Phone: 618-997-5266
  • Fax: 618-997-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036114761
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: