Healthcare Provider Details

I. General information

NPI: 1225090566
Provider Name (Legal Business Name): MICHELLE J. GOTTSCHLICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 HIGHWAY 99 SUITE 260
EDMONDS WA
98026-8012
US

IV. Provider business mailing address

16504 9TH SEAVE 106
MILL CREEK WA
98012-6388
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-2650
  • Fax: 425-774-2643
Mailing address:
  • Phone: 425-977-4620
  • Fax: 425-745-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD60544549
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: