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General NPI Number Information
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NPI Number | 1902828049
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Entity Type | Individual
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Provider Name | BRADLEY TODD KOVACH MD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 801 ANCHOR RODE DR STE 100
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City | NAPLES
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State | FL
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Zip | 34103-2742
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Country | US
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Telephone | 239-263-1717
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Fax | 239-403-9410
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Provider Business Mailing Address
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Address Line | 801 ANCHOR RODE DR STE 100
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City | NAPLES
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State | FL
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Zip | 34103-2742
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Country | US
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Telephone | 239-263-1717
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Fax | 239-403-9410
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2006012910
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | ME98276
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME98276
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License Number State | FL
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