Individual
CHAMPA GOWDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2709 N KNOXVILLE AVE, PEORIA, IL 61604-2867
(309) 688-2117
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0001
(309) 672-4809
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361089691
—
IL
01
—
090147
HEALTH ALLIANCE
IL
01
—
472011
HEALTHLINK
IL
01
—
7215059
BCBS PPO
IL
01
—
IL01L1
JOHN DEERE
IL
01
—
P00144764
RAILROAD MEDICARE
IL
Enumeration date
07/28/2006
Last updated
07/08/2007
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