Michael John Gothelf, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G15676 Issued in CA

Practice address

115 Country Club Drive
Mill Valley, CA 94941

Phone

(415) 383-8947

Fax

(415) 383-6574

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932256468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 COUNTRY CLUB DRIVE",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-383-8947",
            "fax_number": "415-383-6574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 COUNTRY CLUB DRIVE",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-383-8947",
            "fax_number": "415-383-6574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTHELF",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G15676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stefanie Gomez, LCSW
• Rina Utami Gondokusumo
• Shirin Gonili, MPT
• Sylvia Lu Goodman, MFT
• Bruce A Gordon, M.D.
• Sara Gottfried, MD
• Tamar Gottlieb
• Lori Granger, LMFT
• Allen Green Jr., MD
• Deanna Lorraine Green

• Diagnostic Radiology Physician in Mill Valley, CA
• Providers in Mill Valley, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.