Provider Demographics
NPI:1922448497
Name:GOTLIN OBGYN & WELLNESS, P.A.
Entity Type:Organization
Organization Name:GOTLIN OBGYN & WELLNESS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GOTLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:786-320-5870
Mailing Address - Street 1:PO BOX 279191
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-9191
Mailing Address - Country:US
Mailing Address - Phone:786-320-5870
Mailing Address - Fax:786-320-5871
Practice Address - Street 1:300 W 41ST ST STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3627
Practice Address - Country:US
Practice Address - Phone:305-280-0643
Practice Address - Fax:305-363-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1300011234261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG38271Medicare UPIN