Provider Demographics
NPI:1104360668
Name:KOTAL, LINDSAY N (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:N
Last Name:KOTAL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4028
Mailing Address - Country:US
Mailing Address - Phone:303-699-3190
Mailing Address - Fax:303-699-3189
Practice Address - Street 1:14100 E ARAPAHOE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4028
Practice Address - Country:US
Practice Address - Phone:303-699-3190
Practice Address - Fax:303-699-3189
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004789363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA.0004789OtherCOLORADO PHYSICIAN ASSISTANT