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Contact Information

MALCOLM D GOTTLICH, MD
1075 MASON AVE
DAYTONA BEACH, FL32117
 Phone: 386-255-4596
 Fax: 386-258-3561
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for MALCOLM D GOTTLICH · (Male)

NPI # 1639158538
Status Active
Credentials MD
Entity Individual
Enumeration date 01/10/2006
Last updated 04/23/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • FL License # ME57439
  • FL Medicaid 007653200
Hospital affiliation(s)
  • TRIDENT MEDICAL CENTER - (Acute Care)
    9330 MEDICAL PLAZA DR
    CHARLESTON, SC 29406
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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