| Sujatha Govindaiah, M.d., S.c. | |
|
4366 Kennedy Dr Suite A East Moline IL 61244-4288 | |
| (309) 796-1512 | |
| (309) 796-1565 |
| Full Name | Sujatha Govindaiah, M.d., S.c. |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 4366 Kennedy Dr, East Moline, Illinois |
| Authorized Official Name and Position | Sujatha Govindaiah (OWNER) |
| Authorized Official Contact | 3097961512 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sujatha Govindaiah, M.d., S.c. 4366 Kennedy Dr Suite A East Moline IL 61244-4288 Ph: (309) 796-1512 | Sujatha Govindaiah, M.d., S.c. 4366 Kennedy Dr Suite A East Moline IL 61244-4288 Ph: (309) 796-1512 |
| NPI Number | 1700090271 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 02/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700090271 | NPI | - | NPPES |
| 36060186 | Medicaid | IL | |
| 8100344 | Other | IL | BCBS |
| 98289 | Other | IA | BCBS WELLMARK |
| K39951 | Other | IL | MEDICARE INDIVIDUAL |
| 654730 | Other | IL | MEDICARE GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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