Provider Demographics
NPI:1619980620
Name:SHEMESH, GARETH ELI (MD)
Entity Type:Individual
Prefix:
First Name:GARETH
Middle Name:ELI
Last Name:SHEMESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 WADSWORTH BLVD
Mailing Address - Street 2:105
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3318
Mailing Address - Country:US
Mailing Address - Phone:303-424-6565
Mailing Address - Fax:303-424-6843
Practice Address - Street 1:4485 WADSWORTH BLVD
Practice Address - Street 2:105
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3318
Practice Address - Country:US
Practice Address - Phone:303-424-6565
Practice Address - Fax:303-424-6843
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34284208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01342849Medicaid
KS200494330BMedicaid
COP00159906OtherRR MEDICARE PIN
COP00159906OtherRR MEDICARE PIN
CO543678Medicare PIN
KS016484003Medicare PIN