MEDICARE: LISA ANN KOVACH RDN

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	133V00000X	Registered Dietitian	4790	OH

General Provider Information

NPI Number	:	1366035560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN KOVACH RDN

Provider Business Mailing Address
First Line	:	970 E WASHINGTON ST
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-3332
Country	:	US
Telephone Number	:	330-721-5144
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 E WASHINGTON ST
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-3332
Country	:	US
Telephone Number	:	330-721-5144
Fax Number	:

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

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	04/08/2026

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Directions to “ LISA ANN KOVACH RDN” Practice Location

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