Healthcare Provider Details

I. General information

NPI: 1275577553
Provider Name (Legal Business Name): SETH GOTTLIEB, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 710
MIAMI BEACH FL
33140-2877
US

IV. Provider business mailing address

4302 ALTON RD STE 710
MIAMI BEACH FL
33140-2877
US

V. Phone/Fax

Practice location:
  • Phone: 305-534-2155
  • Fax: 305-534-2035
Mailing address:
  • Phone: 305-534-2155
  • Fax: 305-534-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME 68259
License Number StateFL

VIII. Authorized Official

Name: DR. SETH GOTTLIEB
Title or Position: OWNER
Credential: MD
Phone: 305-534-2155