Healthcare Provider Details

I. General information

NPI: 1699000844
Provider Name (Legal Business Name): MAYURI P. GOTHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST # MC3240
DENVER CO
80204-4597
US

IV. Provider business mailing address

601 S BROADWAY # MC3240
DENVER CO
80209-4081
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 303-436-6000
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125052457
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberDR.0070088
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME115701
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: