MEDICARE: DR. NARENDRA GODBOLE 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
1	207R00000X	Internal Medicine Physician	25557	AZ

General Provider Information

NPI Number	:	1396745956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NARENDRA GODBOLE M.D.

Provider Business Mailing Address
First Line	:	21681 N 77TH AVE STE 1410
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2133
Country	:	US
Telephone Number	:	623-312-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	21681 N 77TH AVE STE 1410
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2133
Country	:	US
Telephone Number	:	623-312-2265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	06/29/2022

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