Provider Demographics
NPI:1992817142
Name:GOVE, CHRISTINE E (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:GOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14712 VICTOR HUGO BLVD N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-6419
Mailing Address - Country:US
Mailing Address - Phone:651-466-1900
Mailing Address - Fax:
Practice Address - Street 1:14712 VICTOR HUGO BLVD N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-6419
Practice Address - Country:US
Practice Address - Phone:651-466-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH94299Medicare UPIN