Provider Demographics
NPI:1306883699
Name:KOVAR, GERALD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MICHAEL
Last Name:KOVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23528 ARMINTA ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5620 WILBUR AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:818-774-9225
Practice Address - Fax:818-774-9225
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G228530Medicaid
WG22853BMedicare ID - Type Unspecified
CAA90799Medicare UPIN