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General NPI Number Information
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NPI Number | 1669465142
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Entity Type | Individual
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Provider Name | KRISTINA MARIE KOVACH DPM
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Gender | Female
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 15800 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3748
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Country | US
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Telephone | 216-227-2194
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Fax | 216-227-2196
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Provider Business Mailing Address
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Address Line | PO BOX 639004
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City | CINCINNATI
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State | OH
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Zip | 45263-9004
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Country | US
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Telephone | 440-895-5056
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Fax | 440-333-2935
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36002928
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License Number State | OH
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