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General NPI Number Information
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NPI Number | 1588600886
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Entity Type | Individual
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Provider Name | MICHAEL H GOTLIB M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 2830 CORUNNA RD
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City | FLINT
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State | MI
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Zip | 48503-3254
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Country | US
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Telephone | 810-235-6812
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Fax | 810-234-7022
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Provider Business Mailing Address
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Address Line | 4856 PANORAMA CIR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2475
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Country | US
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Telephone | 248-496-5209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301035009
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License Number State | MI
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