Provider Demographics
NPI:1285881003
Name:KOVATCH, LUKE WARNER (DPM)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:WARNER
Last Name:KOVATCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S DAMEN AVE
Mailing Address - Street 2:7TH FLOOR PODIATRY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3728
Mailing Address - Country:US
Mailing Address - Phone:312-569-7264
Mailing Address - Fax:
Practice Address - Street 1:5241 S CICERO AVE
Practice Address - Street 2:STE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4967
Practice Address - Country:US
Practice Address - Phone:773-284-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005372213ES0103X
KY00361213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery