Provider Demographics
NPI:1508832387
Name:GOTTLIEB, KLAUS T (MD)
Entity Type:Individual
Prefix:DR
First Name:KLAUS
Middle Name:T
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1551 BISHOP ST
Mailing Address - Street 2:STE 450
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4635
Mailing Address - Country:US
Mailing Address - Phone:805-434-2434
Mailing Address - Fax:805-540-2033
Practice Address - Street 1:1551 BISHOP ST
Practice Address - Street 2:STE 450
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-434-2434
Practice Address - Fax:805-540-2033
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC146628207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805288400Medicaid
WA8235491Medicaid
ID805288400Medicaid