Provider Demographics
NPI:1366537615
Name:KOVACH, DREW A (MD)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:A
Last Name:KOVACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 SOUTH ST
Mailing Address - Street 2:SUITE 3404
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5052
Mailing Address - Country:US
Mailing Address - Phone:808-531-5815
Mailing Address - Fax:888-981-1554
Practice Address - Street 1:415 SOUTH ST
Practice Address - Street 2:SUITE 3404
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5052
Practice Address - Country:US
Practice Address - Phone:808-531-5815
Practice Address - Fax:888-981-1554
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-8012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000001131OtherHMSA BILLING NUMBER
HI002199-01Medicaid
HI000001131OtherHMSA BILLING NUMBER
HID24281Medicare UPIN