institution
Sujatha Govindaiah, M.d., S.c.
Adult Mental Health Clinic/Center in East Moline, Illinois
NPI 1700090271

Sujatha Govindaiah, M.d., S.c. is an Adult Mental Health Clinic/Center based in East Moline, IL and is specialized in Adult Mental Health. Sujatha Govindaiah, M.d., S.c. practices in East Moline, IL. The NPI Number for Sujatha Govindaiah, M.d., S.c. is 1700090271 and holds a License No. (Illinois).

The current practice location address for Sujatha Govindaiah, M.d., S.c. is 4366 Kennedy Dr, East Moline, IL and can be reached out via phone at 309-796-1512 and via fax at 309-796-1565.

Location: 4366 Kennedy Dr, East Moline, IL, 61244-4288
institution
Provider Profile Details
NPI Number
1700090271
Provider Name
Sujatha Govindaiah, M.d., S.c.
Credential
Provider Entity Type
Organization
Address
4366 Kennedy Dr, East Moline, IL, 61244-4288
Phone Number
309-796-1512
Fax Number
309-796-1565
Provider Enumeration Date
05/10/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
36060186 05 IL
8100344 01 IL BCBS
98289 01 IA BCBS WELLMARK
K39951 01 IL MEDICARE INDIVIDUAL
654730 01 IL MEDICARE GROUP
institution
Provider Business Practice Location Address Details
Address
4366 Kennedy Dr
City
State
Zip
61244-4288
Phone Number
309-796-1512
Fax Number
309-796-1565
person
Provider Business Mailing Address Details
Address
4366 Kennedy Dr
City
State
Zip
61244-4288
Phone Number
309-796-1512
Fax Number
309-796-1565
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adult Mental Health
Taxonomy
License No.
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Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
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