Organization
PORT HURON NEUROLOGIC ASSOCIATES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD RALPH KOVAR D.O. (PRESIDENT)
(810) 982-0100
Entity
Organization
Contact information
Practice address
3825 24TH AVE, FORT GRATIOT, MI 48059-4100
(810) 982-0100
(810) 982-0365
Mailing address
3825 24TH AVE, FORT GRATIOT, MI 48059-4100
(810) 982-0100
(810) 982-0365
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
5101011111
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3072470-11
—
MI
01
—
5740293
BCBS
MI
Enumeration date
03/19/2008
Last updated
10/29/2019
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