Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036116696 | IL |
NPI | 1477553931 |
---|---|
Provider Name | Dr. Renu C Govindaiah |
First Address | Springfield, IL 62703-2403 |
Second Address | Springfield, IL 62703-2403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 22/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036116696 | (05) | IL |
I13951 | (02) | |
P00339144 | RR MEDICARE (01) | IL |