MEDICARE: KIMBERLY E MONDAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician	J4364	TX
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	J4364	TX
3	2084N0400X	Neurology Physician	J4364	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00X185	OTHER	TX	MEDICARE GROUP PTAN - BRAZORIA
5	DB6392	OTHER		RAILROAD MEDICARE GROUP PTAN
6	00106W	OTHER	TX	MEDICARE GROUP PTAN - HARRIS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0035TD	OTHER	TX	BLUE CROSS BLUE SHIELD OF TEXAS GROUP RECORD NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8DC610	OTHER	TX	BLUE CROSS BLUE SHIELD OF TEXAS INDIVIDUAL RECORD NUMBER

General Provider Information

NPI Number	:	1114908753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY E MONDAY MD

Provider Business Mailing Address
First Line	:	6410 FANNIN ST STE 1014
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5301
Country	:	US
Telephone Number	:	832-325-7080
Fax Number	:	713-512-2239

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST STE 1014
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	832-325-7080
Fax Number	:	713-512-2239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	10/25/2019

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Directions to “ KIMBERLY E MONDAY MD” Practice Location

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