Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10796 | MI |
Y | 213EG0000X | General Practice | 10796 | MI |
NPI | 1003093048 |
---|---|
Provider Name | Dr. Allen Edward Godell |
First Address | Dearborn, MI 48124-1493 |
Second Address | Dearborn, MI 48124-1493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 22/01/2008 |