Provider Demographics
NPI:1790812493
Name:GOGIN, MARGARET A (PT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:GOGIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:A
Other - Last Name:GAHAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3333 N MAYFAIR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3219
Mailing Address - Country:US
Mailing Address - Phone:414-302-0770
Mailing Address - Fax:
Practice Address - Street 1:3333 N MAYFAIR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3219
Practice Address - Country:US
Practice Address - Phone:414-302-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9579208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI81025-0007Medicare ID - Type Unspecified
WIQ47753Medicare UPIN