Healthcare Provider Details

I. General information

NPI: 1871506808
Provider Name (Legal Business Name): MICHAEL STUART GOTTLIEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 N FAIR OAKS AVE # G-151
PASADENA CA
91103-1620
US

IV. Provider business mailing address

1845 N FAIR OAKS AVE # G-151
PASADENA CA
91103-1620
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-7999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG34195
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG34195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: