Healthcare Provider Details

I. General information

NPI: 1477498608
Provider Name (Legal Business Name): MATTHEW BOOTSMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 TURNPIKE DR STE 430
WESTMINSTER CO
80031-7056
US

IV. Provider business mailing address

8787 W ALAMEDA AVE
LAKEWOOD CO
80226-2824
US

V. Phone/Fax

Practice location:
  • Phone: 720-799-7306
  • Fax:
Mailing address:
  • Phone: 630-280-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: