Provider Demographics
NPI:1811424781
Name:GODAR, MADELINE CLAIRE (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:CLAIRE
Last Name:GODAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 SW STATE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7079
Mailing Address - Country:US
Mailing Address - Phone:515-964-6999
Mailing Address - Fax:
Practice Address - Street 1:2515 SW STATE ST STE 200
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7079
Practice Address - Country:US
Practice Address - Phone:515-964-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR-10854OtherRESIDENT LICENSE NUMBER