MEDICARE: MONIQUE D. GILLMAN 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	207V00000X	Obstetrics & Gynecology Physician	Q2551	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	-027	OTHER	VA	TRICARE/CHAMPUS
2	1154367829	OTHER	VA	CIGNA
3	1154367829	OTHER	VA	SEDGWICK CMS
4	1154367829	OTHER	VA	COVENTRY NETWORK
5	1154367829	OTHER	VA	VIRGINIA HEALTH NETWORK
6	1154367829	OTHER	VA	UNITED HEALTHCARE
7	1154367829	OTHER	VA	MULTIPLAN
8	1154367829	OTHER	VA	CORVEL
9	1154367829	OTHER	VA	OPTIMA HEALTH
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	1154367829	OTHER	VA	VIRGINIA PREMIER HEALTH PLAN
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	530684	OTHER	VA	ANTHEM BC/BS
14	1154367829	OTHER	VA	USA MANAGED CARE
15	1154367829	OTHER	VA	AETNA

General Provider Information

NPI Number	:	1154367829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE D. GILLMAN MD

Provider Business Mailing Address
First Line	:	6410 FANNIN ST STE 350
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3004
Country	:	US
Telephone Number	:	832-325-7131
Fax Number	:	713-512-2216

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST STE 350
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3004
Country	:	US
Telephone Number	:	832-325-7131
Fax Number	:	713-512-2216

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	11/25/2020

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