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NPI Code Detail

MEDICARE: DR. MINI B GODDARD M.D.

MEDICARE: DR. MINI B GODDARD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician35067560OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326033754
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MINI B GODDARD M.D.
Provider Business Mailing Address
First Line : PO BOX 74008272
Second Line :
City : CHICAGO
State : IL
Zip : 60674-8272
Country : US
Telephone Number : 702-899-0595
Fax Number : 702-977-1496
Provider Business Practice Location Address
First Line : 1060 EASTWIND DR
Second Line :
City : WESTERVILLE
State : OH
Zip : 43081-3331
Country : US
Telephone Number : 872-231-3162
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 10/03/2025

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Directions to “ DR. MINI B GODDARD M.D.” Practice Location

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