Provider Demographics
NPI:1275523284
Name:LOTHE, COLETTE JOY (MD)
Entity type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:JOY
Last Name:LOTHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLETTE
Other - Middle Name:JOY
Other - Last Name:ROSSMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1438 44TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-2415
Mailing Address - Country:US
Mailing Address - Phone:641-691-3863
Mailing Address - Fax:
Practice Address - Street 1:1438 44TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-2415
Practice Address - Country:US
Practice Address - Phone:641-691-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35573208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0433227Medicaid
IA0433227Medicaid
IAI21664Medicare PIN