Healthcare Provider Details

I. General information

NPI: 1992817142
Provider Name (Legal Business Name): CHRISTINE E GOVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE BERG

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14712 VICTOR HUGO BLVD N
HUGO MN
55038-6419
US

IV. Provider business mailing address

14712 VICTOR HUGO BLVD N
HUGO MN
55038-6419
US

V. Phone/Fax

Practice location:
  • Phone: 651-466-1900
  • Fax:
Mailing address:
  • Phone: 651-466-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45665
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: