MEDICARE: MICHAEL T KOVALCHIK M.D.

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	207RN0300X	Nephrology Physician	020094	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	010020094CT01	OTHER	ANTHEM
2	539143	OTHER	AETNA
3	P3600333	OTHER	OXFORD
4	00120094800	OTHER	ANTHEM FAMILY
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	752466	OTHER	CONNECTICARE
7	040477	OTHER	HEALTH NET

General Provider Information

NPI Number	:	1124003892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T KOVALCHIK M.D.

Provider Business Mailing Address
First Line	:	780 LITCHFIELD ST
Second Line	:	SUITE200
City	:	TORRINGTON
State	:	CT
Zip	:	06790-6268
Country	:	US
Telephone Number	:	860-489-1984
Fax Number	:	860-496-2195

Provider Business Practice Location Address
First Line	:	780 LITCHFIELD ST
Second Line	:	SUITE200
City	:	TORRINGTON
State	:	CT
Zip	:	06790-6268
Country	:	US
Telephone Number	:	860-489-1984
Fax Number	:	860-496-2195

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	12/03/2009

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Directions to “ MICHAEL T KOVALCHIK M.D.” Practice Location

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