Individual
DR. CHARLES MICHAEL GODDARD II
Active
Individual
DR. CHARLES MICHAEL GODDARD II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
059637
MI
208000000X
Pediatrics Physician
Primary
069707
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059637
MI LICENSE
MI
01
—
11293017
CAQH PROVIDER ID
MI
05
—
328339
—
MI
01
—
69707
OH LICENSE
OH
Enumeration date
12/15/2006
Last updated
03/07/2023
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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