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Individual
CASSONDRA LYNN KOVACH
Active
Individual
CASSONDRA LYNN KOVACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56450-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-30787
PHP PROV #
—
01
—
0800311522
BCBS MI PROV #
MI
05
—
1043201338
—
WI
01
—
2397259
UNITED HEALTHCARE
—
01
—
31354
HEALTH PLAN OF MI
MI
05
—
4615612
—
MI
01
—
CK083274
STATE LICENSE #
MI
01
—
P00160742
RAILROAD MEDICARE
—
01
—
P31738F
BLUE CARE NETWORK
MI
Enumeration date
11/04/2005
Last updated
10/18/2023
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