Provider Demographics
NPI:1396759742
Name:GILLOGLEY, KATHERINE MUELLER (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MUELLER
Last Name:GILLOGLEY
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8120 TIMBERLAKE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5412
Practice Address - Country:US
Practice Address - Phone:916-681-6000
Practice Address - Fax:916-681-6001
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56083207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA005823OtherHEALTH NET
CA90026763OtherPACIFICARE
CAG56083OtherBLUE CROSS
CA1089846OtherGREAT WEST
CAMCMG169600OtherWESTERN HEALTH ADVANTAGE
CA000810342829OtherPHCS
CA233715OtherUNITED HEALTHCARE
CA512244OtherFIRST HEALTH
CA7297OtherINTERPLAN
CA00G560830OtherBLUE SHIELD
CA00G560830Medicaid
CA3181696OtherCIGNA
CA4508714OtherAETNA
CA00G560830OtherBLUE SHIELD
CA7297OtherINTERPLAN