DR. PAUL J KOVACK (NPI# 1245221621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245221621 |
| Entity Type | Individual |
| Full Name | DR. PAUL J KOVACK |
| Credential | D.O. |
| Practice Address |
2122 Health Dr Sw Wyoming MI 49519-9698 |
| Mailing Address |
5900 Byron Center Ave Sw Medical Administration Wyoming MI 49519-9606 |
| Practice Telephone | 6162525950 |
| Practice Fax Number | 6162525956 |
| Mailing Telephone | 6162523243 |
| Mailing Fax Number | 6162520260 |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2017-12-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
5101011064 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BSBCM PIN | PK011064 | 01 |
| MI | 3222989 | 05 | |
| MI | STATE LICENSE | 5101011064 | 01 |
| MI | RAILROAD MEDICARE | 060037412 | 01 |
| Street Address |
2122 HEALTH DR SW |
| City | WYOMING |
| State | MI |
| Zip Code | 49519-9698 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952301038 | Larry Jose Diaz | Specialist | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2005-07-29 |
| 1174091730 | Sarah Beth Dickinson | Nurse Practitioner | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2018-11-12 |
| 1508341686 | Margaret Maureen O'hara | Nurse Practitioner | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2018-09-25 |
| 1194210914 | Katelyn Gettel | Nurse Practitioner | 2122 Health Dr Sw, Suite 133, Wyoming, MI 49519 | 2018-06-25 |
| 1184119901 | Emily Mccloskey | Nurse Practitioner | 2122 Health Dr Sw, Suite 133, Wyoming, MI 49519 | 2018-06-25 |
| 1174025027 | Melissa Pillai | Nurse Practitioner | 2122 Health Dr Sw, Wyoming, MI 49519 | 2018-03-07 |
| 1497139653 | Danielle Rush | Nurse Practitioner | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2015-07-16 |
| 1184015414 | Jennifer J Richardson | Physician Assistant | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2015-02-09 |
| 1891101911 | Katie Waite | Physician Assistant | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2014-07-09 |
| 1487078465 | Chelsea Ann Ellis | Physician Assistant | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2014-02-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609364009 | Alexandra K Hylen | Dentist | 4489 Byron Center Ave Sw Ste A, Wyoming, MI 49519 | 2018-05-01 |
| 1962925685 | Nicole Lee Kolasa | Rehabilitation Counselor | 2038 Melvin St. Sw, Wyoming, MI 49519 | 2017-07-25 |
| 1720534472 | Michael Ash | Rehabilitation Practitioner | 1870 36th Street, Wyoming, MI 49519 | 2016-08-31 |
| 1891248993 | Kayleigh Saucier | Family Medicine | 5900 Byron Center Avenue Se, Wyoming, MI 49519 | 2016-07-26 |
| 1093112799 | Wmro LLC | Radiology | 5950 Metro Way, Wyoming, MI 49519 | 2014-11-24 |
| 1033547658 | Maranda Catherine Gary | Nurse Practitioner | 2122 Health Drive, Wyoming, MI 49519 | 2013-10-16 |
| 1144657800 | Diana Ro | Psychologist | 4211 Parkway Place Sw, #100, Wyoming, MI 49519 | 2013-09-26 |
| 1386077873 | Lindsey Elizabeth Chorney | Nurse Practitioner | 2122 Health Drive Sw, Suite 133, Wyoming, MI 49519 | 2013-08-20 |
| 1124377163 | Vision and Sensory Center of Michigan LLC | Optometrist | 4467 Byron Center Ave., Wyoming, MI 49519 | 2012-09-06 |
| 1881940203 | Judah | Durable Medical Equipment & Medical Supplies | 2975 Waterchase Way Sw Suite 307, Wyoming, MI 49519 | 2012-08-03 |
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| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548649189 | Metro Health Cardiology Clinic Corporation | Internal Medicine | 5900 Byron Center Ave Sw, Wyoming, MI 49519-9606 | 2015-05-28 |
| 1881827095 | Rony Dimitrious Gorges | Internal Medicine | 2122 Health Dr Sw Ste 133, Wyoming, MI 49519-9698 | 2009-09-03 |
| 1932341294 | Ali A Saab | Internal Medicine | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2009-04-01 |
| 1891995536 | Laura M Franey | Internal Medicine | 6105 Wilson Ave Sw, Suite 101, Wyoming, MI 49418-9714 | 2007-07-20 |
| 1447471636 | Barbara Karenko | Internal Medicine | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2007-05-02 |
| 1336268747 | Michael W Mcnamara | Internal Medicine | 6105 Wilson Ave Sw, Wyoming, MI 49418-9714 | 2007-03-28 |
| 1528028412 | Fadi A Saab | Internal Medicine | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2006-03-24 |
| 1134103732 | John Allen Key | Internal Medicine | 5900 Byron Center Ave Sw, Wyoming, MI 49519-9606 | 2005-12-06 |
| 1255312302 | Matthew Warren Sevensma | Internal Medicine | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2005-11-07 |
| 1962493395 | Eric Thomas Walchak | Internal Medicine | 2122 Health Dr Sw, Wyoming, MI 49519-9698 | 2005-11-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.