Basic Information
| Provider Information | |||||||||
| NPI: | 1427292895 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOTTSCHALK | ||||||||
| FirstName: | LIONEL | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4386 TRAIL BOSS DR | ||||||||
| Address2: | |||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801047512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192098630 | ||||||||
| FaxNumber: | 7194733553 | ||||||||
| Practice Location | |||||||||
| Address1: | 4386 TRAIL BOSS DR | ||||||||
| Address2: | |||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801047512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192098630 | ||||||||
| FaxNumber: | 7194733553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2009 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | DR. 0055408 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.