Individual
DR. MUKUND GODBOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 W HARLEM AVE, MONMOUTH, IL 61462-1007
(309) 734-3141
Mailing address
1000 W HARLEM AVE, MONMOUTH, IL 61462-1007
(309) 734-3141
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
17209
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02820846
—
MS
01
—
C03242
MEDICARE CAHABA
MS
01
—
P00269826
PALMETTO MEDICARE RAILROA
MS
Enumeration date
10/16/2006
Last updated
05/16/2014
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