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General NPI Number Information
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NPI Number | 1336333137
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Entity Type | Organization
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Legal Business Name | GERALD G. GOVIN, MD,SC
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 16535 W BLUEMOUND RD SUITE 222
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City | BROOKFIELD
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State | WI
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Zip | 53005-5936
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Country | US
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Telephone | 262-786-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 16535 W BLUEMOUND RD SUITE 222
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City | BROOKFIELD
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State | WI
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Zip | 53005-5936
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Country | US
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Telephone | 262-786-3222
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR /OWNER
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Name | DR. GERALD G. GOVIN
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Credential | M.D.
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Telephone | 262-786-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21950
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License Number State | WI
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