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General NPI Number Information
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NPI Number | 1629490495
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Entity Type | Organization
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Legal Business Name | GOTTLIEB MEDICAL GROUP
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 5901 W OLYMPIC BLVD SUITE 401
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City | LOS ANGELES
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State | CA
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Zip | 90036-4667
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Country | US
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Telephone | 323-816-3193
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 CHELSEA RD #334
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City | SAN MARINO
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State | CA
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Zip | 91108-2419
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL S GOTTLIEB
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Credential | M.D.
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Telephone | 323-816-3193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | G34195
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G34195
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License Number State | CA
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