Provider Demographics
NPI:1013076900
Name:GOVILA, VEENA
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:
Last Name:GOVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43750 WOODWARD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5063
Mailing Address - Country:US
Mailing Address - Phone:248-335-8177
Mailing Address - Fax:
Practice Address - Street 1:43750 WOODWARD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5063
Practice Address - Country:US
Practice Address - Phone:248-335-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVG033009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVG033009OtherMEDICAL LICENSE
MI101929OtherCARE CHOICES
MIC4083OtherMCARE
MI1106393062OtherBLUECROSSBLUESHIELD
MI1106393062OtherBLUECROSSBLUESHIELD
MIA78384Medicare UPIN