Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 1854 | SD |
NPI | 1063437085 |
---|---|
Provider Name | Stephen M Kovarik |
First Address | Rapid City, SD 57701-7316 |
Second Address | Rapid City, SD 57701-7316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 30/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6700700 | (05) | SD |
D25412 | (02) | SD |