| Port Huron Neurologic Associates P.c. | |
|
3825 24th Ave Fort Gratiot MI 48059-4100 | |
| (810) 982-0100 | |
| (810) 982-0365 |
| Full Name | Port Huron Neurologic Associates P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3825 24th Ave, Fort Gratiot, Michigan |
| Authorized Official Name and Position | Richard Ralph Kovar (PRESIDENT) |
| Authorized Official Contact | 8109820100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Huron Neurologic Associates P.c. 3825 24th Ave Fort Gratiot MI 48059-4100 Ph: (810) 982-0100 | Port Huron Neurologic Associates P.c. 3825 24th Ave Fort Gratiot MI 48059-4100 Ph: (810) 982-0100 |
| NPI Number | 1699946459 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 10/29/2019 |
| Medicare PECOS PAC ID | 1557440245 |
|---|---|
| Medicare Enrollment ID | O20080506000808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699946459 | NPI | - | NPPES |
| 3072470-11 | Medicaid | MI | |
| 5740293 | Other | MI | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 5101011111 (Michigan) | Primary |
| Provider Name | Richard R Kovar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1235147844 PECOS PAC ID: 8820177512 Enrollment ID: I20080506000803 |
| Provider Name | Adrian R Lahr |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891099131 PECOS PAC ID: 0143406207 Enrollment ID: I20110525000702 |
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