Healthcare Provider Details

I. General information

NPI: 1861501082
Provider Name (Legal Business Name): CHRISTOPHER J KOVANDA MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4999 FRANCE AVE S STE 210
EDINA MN
55410-2168
US

IV. Provider business mailing address

9325 UPLAND LN N STE 205
MAPLE GROVE MN
55369-4474
US

V. Phone/Fax

Practice location:
  • Phone: 612-335-9032
  • Fax:
Mailing address:
  • Phone: 763-416-0676
  • Fax: 763-416-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number41657
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: