Provider Demographics
NPI:1225090566
Name:GOTTSCHLICH, MICHELLE J (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:GOTTSCHLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16504 9TH SEAVE 106
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6388
Mailing Address - Country:US
Mailing Address - Phone:425-977-4620
Mailing Address - Fax:425-745-9836
Practice Address - Street 1:21600 HIGHWAY 99
Practice Address - Street 2:SUITE 260
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8012
Practice Address - Country:US
Practice Address - Phone:425-774-2650
Practice Address - Fax:425-774-2643
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60544549207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2043427Medicaid
H18606Medicare UPIN
WAG8941980Medicare PIN