Provider Demographics
NPI:1447886791
Name:KOVACH, MIKE JOSEPH (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:JOSEPH
Last Name:KOVACH
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 MAZUREK BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-3974
Mailing Address - Country:US
Mailing Address - Phone:850-380-6493
Mailing Address - Fax:
Practice Address - Street 1:2929 LANGLEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7355
Practice Address - Country:US
Practice Address - Phone:850-474-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP-934171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist