Provider Demographics
NPI:1104360668
Name:KOTAL, LINDSAY N (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:N
Last Name:KOTAL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1151 ALOHA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108
Mailing Address - Country:US
Mailing Address - Phone:720-330-1305
Mailing Address - Fax:720-452-2079
Practice Address - Street 1:1151 ALOHA ST
Practice Address - Street 2:STE 100
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-2388
Practice Address - Country:US
Practice Address - Phone:720-330-1305
Practice Address - Fax:720-452-2079
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.4789363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA.0004789OtherCOLORADO PHYSICIAN ASSISTANT