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Individual

DR. SUJATHA GOVINDAIAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
4360 KENNEDY DR, SUITE 3, EAST MOLINE, IL 61244-4251
(309) 796-1512
(309) 796-1887
Mailing address
4360 KENNEDY DR, SUITE 3, EAST MOLINE, IL 61244-4251
(309) 796-1512
(309) 796-1887

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036060186
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036060186
IL
Enumeration date
10/10/2005
Last updated
04/06/2009
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