Provider Demographics
NPI:1609987213
Name:GOTTUS, MICHAEL JAY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAY
Last Name:GOTTUS
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2417
Mailing Address - Fax:970-652-2927
Practice Address - Street 1:1035 GARDEN OF THE GODS RD STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3416
Practice Address - Country:US
Practice Address - Phone:719-365-3200
Practice Address - Fax:719-365-7680
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-01-13
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00179400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant