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CASSONDRA LYNN KOVACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
4131 MERIDIAN DR, WINDSOR, WI 53598-9699
(608) 846-3741
(608) 846-7898
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531

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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