# GODDARD CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427266113
- **Authorized official:** DR. KENNETH WILLIAM DEBYLE D.O. (PRESIDENT)
- **Authorized official phone:** (313) 386-3960

## Contact information

- **Practice address:** 17234 GODDARD RD, ALLEN PARK, MI 48101-4100
- **Practice address phone:** (313) 386-3960
- **Practice address fax:** (313) 386-0145
- **Mailing address:** 17234 GODDARD RD, ALLEN PARK, MI 48101-4100
- **Mailing address phone:** (313) 386-3960
- **Mailing address fax:** (313) 386-0145

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 5101005616 | MI | Yes |

## Other

- **Enumeration date:** 05/18/2007
- **Last updated:** 08/22/2020