Organization
SUJATHA GOVINDAIAH, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUJATHA GOVINDAIAH MD (OWNER)
(309) 796-1512
Entity
Organization
Contact information
Practice address
4366 KENNEDY DR, SUITE A, EAST MOLINE, IL 61244-4288
(309) 796-1512
(309) 796-1565
Mailing address
4366 KENNEDY DR, SUITE A, EAST MOLINE, IL 61244-4288
(309) 796-1512
(309) 796-1565
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36060186
—
IL
01
—
654730
MEDICARE GROUP
IL
01
—
8100344
BCBS
IL
01
—
98289
BCBS WELLMARK
IA
01
—
K39951
MEDICARE INDIVIDUAL
IL
Enumeration date
05/10/2007
Last updated
02/28/2008
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