Active NPI
Matthew John Kovach
- Registered Nurse
- New Baltimore, MI
National Provider Identifier
1972342111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4704363110
- Practice address
- 54459 Malibu LN
New Baltimore, MI 48047-6418 - Phone
- (586) 201-2795
- NPI assigned
- May 20, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704363110 | MI | Primary |
Addresses
Primary practice location
54459 Malibu LN
New Baltimore, MI 48047-6418
Mailing address
54459 Malibu LN
New Baltimore, MI 48047-6418
Phone (586) 201-2795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704363110 | MI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716163200000",
"number": "1972342111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "54459 MALIBU LN",
"city": "NEW BALTIMORE",
"state": "MI",
"postal_code": "480476418",
"telephone_number": "586-201-2795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "54459 MALIBU LN",
"city": "NEW BALTIMORE",
"state": "MI",
"postal_code": "480476418",
"telephone_number": "586-201-2795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOVACH",
"first_name": "MATTHEW",
"middle_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-20",
"last_updated": "2024-05-20",
"certification_date": "2024-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704363110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Baltimore, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.