Provider Demographics
NPI:1861626343
Name:GILLIS, ADA MARGARET (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:MARGARET
Last Name:GILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADA
Other - Middle Name:MARGARET
Other - Last Name:LOUGHHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2955 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-1526
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074238207Q00000X
PAMT195073207Q00000X
CO054360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO025207OtherKAISER COMMERCIAL NUMBER
CO71786317Medicaid
CO025207OtherKAISER COMMERCIAL NUMBER