Provider Demographics
NPI:1154367829
Name:GILLMAN, MONIQUE D (MD)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:D
Last Name:GILLMAN
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 1:6410 FANNIN ST STE 350
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3004
Mailing Address - Country:US
Mailing Address - Phone:832-325-7131
Mailing Address - Fax:713-512-2216
Practice Address - Street 1:6410 FANNIN ST STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3004
Practice Address - Country:US
Practice Address - Phone:832-325-7131
Practice Address - Fax:713-512-2216
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2551207V00000X
MI4301078731207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-027OtherTRICARE/CHAMPUS
VA1154367829OtherCIGNA
VA1154367829OtherSEDGWICK CMS
VA1154367829OtherCOVENTRY NETWORK
VA1154367829OtherVIRGINIA HEALTH NETWORK
VA1154367829OtherUNITED HEALTHCARE
VA1154367829OtherMULTIPLAN
VA1154367829OtherCORVEL
VA1154367829OtherOPTIMA HEALTH
NC1154368729Medicaid
VA1154367829OtherVIRGINIA PREMIER HEALTH PLAN
VA1154367829Medicaid
VA530684OtherANTHEM BC/BS
VA1154367829OtherUSA MANAGED CARE
VA1154367829OtherAETNA
VAVVF683AMedicare PIN
VA1154367829OtherUNITED HEALTHCARE