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General NPI Number Information
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NPI Number | 1407012834
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Entity Type | Individual
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Provider Name | HENRI GODBOLD M.D
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Gender | Male
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 20901 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-1904
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Country | US
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Telephone | 313-564-5510
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Fax | 248-581-8839
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Provider Business Mailing Address
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Address Line | 18000 W 9 MILE RD STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4020
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Country | US
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Telephone | 248-336-4000
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Fax | 248-336-9137
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 4301080800
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301080800
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301080800
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License Number State | MI
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