Healthcare Provider Details

I. General information

NPI: 1649196775
Provider Name (Legal Business Name): JOSEPH GOTTINGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W HART RD
BELOIT WI
53511-2230
US

IV. Provider business mailing address

1615 N 59TH ST
MILWAUKEE WI
53208-2167
US

V. Phone/Fax

Practice location:
  • Phone: 262-949-1469
  • Fax:
Mailing address:
  • Phone: 262-949-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: