Provider Demographics
NPI:1407466238
Name:L J GOTTSCHALK, LLC
Entity Type:Organization
Organization Name:L J GOTTSCHALK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GOTTSCHALK
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:858-401-3241
Mailing Address - Street 1:757 INTERNATIONAL ISLE DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3482
Mailing Address - Country:US
Mailing Address - Phone:858-401-3241
Mailing Address - Fax:
Practice Address - Street 1:4386 TRAIL BOSS DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7512
Practice Address - Country:US
Practice Address - Phone:858-401-3241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty