Healthcare Provider Details

I. General information

NPI: 1518958107
Provider Name (Legal Business Name): DANIELLE GOTTLIEB SEN MD MPH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE GOTTLIEB MD

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

850 POPLAR AVE
MEMPHIS TN
38105-4607
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax: 901-287-4646
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number226033
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD89072
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number300440
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number55447
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: