MEDICARE: MR. CORY M KOVAC PA-C

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
1	207P00000X	Emergency Medicine Physician	3363	AZ
2	363A00000X	Physician Assistant	3363	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1093753709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CORY M KOVAC PA-C

Provider Business Mailing Address
First Line	:	729 S BURK ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-2815
Country	:	US
Telephone Number	:	480-588-6213
Fax Number	:

Provider Business Practice Location Address
First Line	:	19350 E SILVER CREEK LN
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-9064
Country	:	US
Telephone Number	:	480-718-5400
Fax Number	:	877-666-4624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	02/02/2015

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