Individual
DR. RENU C GOVINDAIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
036116696
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036116696
—
IL
01
—
P00339144
RR MEDICARE
IL
Enumeration date
07/27/2005
Last updated
05/22/2020
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