MEDICARE: MICHEAL R COVAULT MD

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	207L00000X	Anesthesiology Physician	04-30920	KS

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	:	1689676298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEAL R COVAULT MD

Provider Business Mailing Address
First Line	:	7718 E OAKMOUNT ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67226-3527
Country	:	US
Telephone Number	:	316-315-0621
Fax Number	:	316-315-0621

Provider Business Practice Location Address
First Line	:	1124 WEST 21ST STREET
Second Line	:
City	:	ANDOVER
State	:	KS
Zip	:	67002
Country	:	US
Telephone Number	:	316-300-4000
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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Directions to “ MICHEAL R COVAULT MD” Practice Location

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