Healthcare Provider Details

I. General information

NPI: 1710041025
Provider Name (Legal Business Name): STEVEN GOTLIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 FULLER CT #1003A
ANN ARBOR MI
48105-2312
US

IV. Provider business mailing address

2222 FULLER CT #1003A
ANN ARBOR MI
48105-2312
US

V. Phone/Fax

Practice location:
  • Phone: 734-662-9191
  • Fax: 734-662-9189
Mailing address:
  • Phone: 734-662-9191
  • Fax: 734-662-9189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301036405
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4301036405
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301036405
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number4301036405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: