Provider Demographics
NPI:1629124235
Name:GOGATE, SHAILA (MD)
Entity Type:Individual
Prefix:
First Name:SHAILA
Middle Name:
Last Name:GOGATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RAMPART WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6429
Mailing Address - Country:US
Mailing Address - Phone:720-858-7600
Mailing Address - Fax:720-858-7605
Practice Address - Street 1:125 RAMPART WAY STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6429
Practice Address - Country:US
Practice Address - Phone:720-858-7600
Practice Address - Fax:970-858-7610
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL-2000390200000X
CO46432207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78001234Medicaid
COI36980OtherUPIN
COI36980OtherUPIN
CO78001234Medicaid