Provider Demographics
NPI:1982017448
Name:GOVINDAN, MORGEN (MD)
Entity Type:Individual
Prefix:
First Name:MORGEN
Middle Name:
Last Name:GOVINDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MORGEN
Other - Middle Name:
Other - Last Name:LEONARD-FLECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD.
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:4313 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102
Practice Address - Country:US
Practice Address - Phone:913-233-4400
Practice Address - Fax:913-264-9976
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018022311208000000X
KS04-41238208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics