Healthcare Provider Details

I. General information

NPI: 1114918869
Provider Name (Legal Business Name): MUHAMMAD MONEM GILLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N SHARTEL AVE SUITE# 700
OKLAHOMA CITY OK
73103-2400
US

IV. Provider business mailing address

1211 N SHARTEL AVE SUITE# 700
OKLAHOMA CITY OK
73103-2400
US

V. Phone/Fax

Practice location:
  • Phone: 405-702-6700
  • Fax: 405-702-6718
Mailing address:
  • Phone: 405-702-6700
  • Fax: 405-702-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number21301
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: