Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Laurel Gotha, PA

Individual provider Physician Assistant · NPI 1912723826

MS. Laurel Gotha, PA is a Physician Assistant in Livonia, Michigan. Qualified in 2024, 2 years ago. Practices with Iha Olma Specialty 1 LLC, a 68-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
2
Licensed in
MI
In the registry since
2024
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

14555 Levan Rd Ste 311 Ste 311
Livonia, MI 48154
Phone: (734) 655-2692
Fax: (734) 655-4218
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601012980 (MI)

Record details

NPI number1912723826
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedNovember 25, 2024
Last updated in NPPESOctober 21, 2025
Certification dateOctober 21, 2025
Mailing address24 Frank Lloyd Wright Drive, Suite J2000, Ann Arbor, MI 48105

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Iha Olma Specialty 1 Llc — 68 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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