Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5502006051 | MI |
NPI | 1003459082 |
---|---|
Provider Name | Megan Kovalcik |
First Address | Chesterfield, MI 48051-3128 |
Second Address | Chesterfield, MI 48051-3128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2019 |
Last Update Date | 23/10/2019 |