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NPI Code Detail

MEDICARE: DR. MICHAEL A. KOVALICK D.O.

MEDICARE: DR. MICHAEL A. KOVALICK D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS009120LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063472389
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL A. KOVALICK D.O.
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-3034
Country : US
Telephone Number : 570-271-6144
Fax Number : 570-271-6578
Provider Business Practice Location Address
First Line : 114 LT MICHAEL CLEARY DR
Second Line :
City : DALLAS
State : PA
Zip : 18612-1649
Country : US
Telephone Number : 570-675-2000
Fax Number : 570-675-1806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 08/28/2020

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