Basic Information
| Provider Information | |||||||||
| NPI: | 1902872674 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVALESKI | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S. MINNESOTA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571053762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 S CLIFF AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053222460 | ||||||||
| FaxNumber: | 6053222470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 12/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 5391 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | S5391 | SD | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 12903 | 05 | ND | MEDICAID | 4995328 | 01 | SD | BLUE CROSS | OTHER | P00191474 | 01 | SD | RR MEDICARE | OTHER | 5391 | 01 | SD | DAKOTACARE | OTHER | 57105P007 | 01 | SD | WPS TRICARE | OTHER | HP43042 | 01 | SD | HEALTHPARTNERS | OTHER | 36792 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 37494 | 01 | IA | BLUE CROSS | OTHER | 704448800 | 05 | MN | MEDICAID | 2235973 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 243567 | 01 | SD | MIDLANDS CHOICE | OTHER | 3100230 | 01 | SD | MEDICA | OTHER | 6004880 | 05 | SD | MEDICAID | 0581967 | 05 | IA | MEDICAID | 296L1KO | 01 | MN | BLUE CROSS | OTHER | 296L1KO | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 406751041580 | 01 | SD | PREFERRED ONE | OTHER | 46022474344 | 05 | NE | MEDICAID |