Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 17209 | MS |
Y | 208600000X | Surgeon | 17209 | MS |
NPI | 1003996125 |
---|---|
Provider Name | Dr. Mukund Godbole |
First Address | Monmouth, IL 61462-1007 |
Second Address | Monmouth, IL 61462-1007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 16/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02820846 | (05) | MS |
C03242 | MEDICARE CAHABA (01) | MS |
C44750 | (02) | |
P00269826 | PALMETTO MEDICARE RAILROA (01) | MS |