Provider Demographics
NPI:1396745956
Name:GODBOLE, NARENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:
Last Name:GODBOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21681 N 77TH AVE STE 1410
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2133
Mailing Address - Country:US
Mailing Address - Phone:623-312-2265
Mailing Address - Fax:
Practice Address - Street 1:21681 N 77TH AVE STE 1410
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2133
Practice Address - Country:US
Practice Address - Phone:623-312-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCGBRMedicare PIN
AZCD5921Medicare PIN