Provider Demographics
NPI:1245292812
Name:SCHOTTSTAEDT, LOUISE E (MD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:E
Last Name:SCHOTTSTAEDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:S
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1925 E ORMAN SUITE 440
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004
Mailing Address - Country:US
Mailing Address - Phone:719-560-4744
Mailing Address - Fax:719-560-4770
Practice Address - Street 1:1925 E ORMAN SUITE 440
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004
Practice Address - Country:US
Practice Address - Phone:719-560-4744
Practice Address - Fax:719-560-4770
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01274836Medicaid
CO803297Medicare ID - Type Unspecified
CO01274836Medicaid