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1902828049

NPI Code Detail

MEDICARE: DR. BRADLEY TODD KOVACH MD

MEDICARE: DR. BRADLEY TODD KOVACH 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	207N00000X	Dermatology Physician	2006012910	MO
2	207ND0101X	MOHS-Micrographic Surgery Physician	ME98276	FL
3	207N00000X	Dermatology Physician	ME98276	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	208189	OTHER		MO-BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902828049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY TODD KOVACH MD

Provider Business Mailing Address
First Line	:	801 ANCHOR RODE DR STE 100
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-2742
Country	:	US
Telephone Number	:	239-263-1717
Fax Number	:	239-403-9410

Provider Business Practice Location Address
First Line	:	801 ANCHOR RODE DR STE 100
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-2742
Country	:	US
Telephone Number	:	239-263-1717
Fax Number	:	239-403-9410

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	10/06/2020

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Directions to “ DR. BRADLEY TODD KOVACH MD” Practice Location

Language	Start Address	Practice Location

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