Individual
PAUL S. GOTLIEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6545 FRANCE AVE S, SUITE 150, EDINA, MN 55435-2131
(952) 848-5600
(952) 848-5556
Mailing address
6545 CROSSTOWN AVE. S, SUITE 150, EDINA, MN 55435
(952) 848-5600
(952) 848-5556
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34200
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0425224
MEDICA HEALTH PLAN
MN
05
—
164202200
—
MN
01
—
1M593GO
BCBS OF MINNESOTA
MN
Enumeration date
06/21/2005
Last updated
03/29/2012
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