Basic Information
| Provider Information | |||||||||
| NPI: | 1558377002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVACS | ||||||||
| FirstName: | HENRIETTA | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1924 K DAUPHIN ISLAND PARKWAY | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366053004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514766330 | ||||||||
| FaxNumber: | 2514766363 | ||||||||
| Practice Location | |||||||||
| Address1: | 1924K DAUPHIN ISLAND PARKWAY | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366053004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514766330 | ||||||||
| FaxNumber: | 2514766363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 00011364 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 510I110271 | 01 | AL | MEDICARE PTAN | OTHER |