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NPI Code Detail

MEDICARE: KAMERON BETHANY GOTTLIEB PA-C

MEDICARE: KAMERON BETHANY GOTTLIEB PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantWI

General Provider Information

NPI Number : 1134050511
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAMERON BETHANY GOTTLIEB PA-C
Provider Business Mailing Address
First Line : 2725 MARSHALL CT APT 304
Second Line :
City : MADISON
State : WI
Zip : 53705-2288
Country : US
Telephone Number : 847-440-6622
Fax Number :
Provider Business Practice Location Address
First Line : 1102 S PARK ST
Second Line :
City : MADISON
State : WI
Zip : 53715-1708
Country : US
Telephone Number : 608-263-3111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “ KAMERON BETHANY GOTTLIEB PA-C” Practice Location

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