Provider Demographics
NPI:1528463007
Name:KOVACIC, SARA LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:LYNN
Last Name:KOVACIC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7906
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:1000 N 16TH ST STE 250
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-599-3555
Practice Address - Fax:765-599-3286
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004545A208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02004545BOtherCSR
KY7100392520Medicaid
IN201280210Medicaid
IN02004545AOtherSTATE LICENSE
IN02004545AOtherSTATE LICENSE
IN02004545AOtherSTATE LICENSE