Provider Demographics
NPI:1902845894
Name:GOVE, MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:GOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:WUEBKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 FEDERAL DR STE 1950
Mailing Address - Street 2:
Mailing Address - City:FORT SNELLING
Mailing Address - State:MN
Mailing Address - Zip Code:55111-4080
Mailing Address - Country:US
Mailing Address - Phone:602-813-1632
Mailing Address - Fax:612-794-3990
Practice Address - Street 1:2206 LONGO DR STE 102
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2977
Practice Address - Country:US
Practice Address - Phone:402-591-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31624207R00000X
CODR.0058006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149163Medicaid
OK200074540BMedicaid
OKI23671Medicare UPIN
OK200074540AMedicaid
OK900522214Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER