| Entity Name: | SETH GOTTLIEB, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Dec 2001 (23 years ago) |
| Document Number: | P01000121880 |
| FEI/EIN Number | 010582605 |
| Address: | 4302 ALTON ROAD, #450, MIAMI BEACH, FL, 33140, US |
| Mail Address: | 4302 ALTON ROAD, #450, MIAMI BEACH, FL, 33140, US |
| ZIP code: | 33140 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275577553 | 2006-06-16 | 2019-05-20 | 4302 ALTON RD STE 710, MIAMI BEACH, FL, 331402877, US | 4302 ALTON RD STE 710, MIAMI BEACH, FL, 331402877, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-534-2155 |
| Fax | 3055342035 |
Authorized person
| Name | DR. SETH GOTTLIEB |
| Role | OWNER |
| Phone | 3055342155 |
Taxonomy
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| License Number | ME 68259 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 26882 |
| State | FL |
| Issuer | MEDICAID |
| Number | 378455000 |
| State | FL |
| Issuer | INDIVIDUAL NPI |
| Number | 1003810763 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GROSSMAN STUART I | Agent | 201 S. BISCAYNE BOULEVARD, MIAMI, FL, 33131 |
| Name | Role | Address |
|---|---|---|
| GOTTLIEB SETH | Director | 11171 REDHAWK STREET, PLANTATION, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| GOTTLIEB SETH | President | 11171 REDHAWK STREET, PLANTATION, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| GOTTLIEB SETH | Secretary | 11171 REDHAWK STREET, PLANTATION, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| GOTTLIEB SETH | Treasurer | 11171 REDHAWK STREET, PLANTATION, FL, 33324 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2021-12-28 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
