Provider Demographics
NPI:1003810763
Name:GOTTLIEB, SETH (MD,FCCP)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:MD,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 ALTON RD STE 940
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2890
Mailing Address - Country:US
Mailing Address - Phone:305-674-2055
Mailing Address - Fax:305-674-2075
Practice Address - Street 1:4302 ALTON RD STE 940
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2890
Practice Address - Country:US
Practice Address - Phone:305-674-2055
Practice Address - Fax:305-674-2075
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 68259207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378455000Medicaid
FL010582605OtherEIN/TAX ID