Individual
DR. KETAN DEEPAK GODBOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1145 S UTICA AVE, STE 460, TULSA, OK 74104-4000
(918) 579-5749
(918) 579-5762
Mailing address
1145 S UTICA AVE, STE 460, TULSA, OK 74104-4000
(918) 579-5749
(918) 579-5762
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29548
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200481220A
—
OK
Enumeration date
07/06/2009
Last updated
07/16/2015
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