Healthcare Provider Details

I. General information

NPI: 1558303305
Provider Name (Legal Business Name): THOMAS JOSEPH KOVACK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6670 PERIMETER DR STE 140
DUBLIN OH
43016-8057
US

IV. Provider business mailing address

6670 PERIMETER DR STE 140
DUBLIN OH
43016-8057
US

V. Phone/Fax

Practice location:
  • Phone: 614-526-2150
  • Fax: 614-526-2151
Mailing address:
  • Phone: 614-526-2150
  • Fax: 614-526-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34008324
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: