Healthcare Provider Details

I. General information

NPI: 1346243326
Provider Name (Legal Business Name): MONIQUE MARIA HOWARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W. FAIRCHILD STREET
DANVILLE IL
61832-3803
US

IV. Provider business mailing address

611 W. PARK STREET
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-431-7900
  • Fax: 217-431-7634
Mailing address:
  • Phone: 217-383-6792
  • Fax: 217-383-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number29710
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: