Provider Demographics
NPI:1336123587
Name:GOVEA, PEARL (MD)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:GOVEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PEARL
Other - Middle Name:
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1340 S DAMEN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1169
Mailing Address - Country:US
Mailing Address - Phone:773-292-4800
Mailing Address - Fax:312-564-4059
Practice Address - Street 1:2 CHASE CORPORATE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1016
Practice Address - Country:US
Practice Address - Phone:773-292-4800
Practice Address - Fax:312-564-4059
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235022207Q00000X
ALMD.32028207Q00000X
TXN6225207Q00000X
FLME110535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL143949Medicaid
TXTXB102889Medicare PIN
AL143949Medicaid
TXTXB102884Medicare PIN