Healthcare Provider Details

I. General information

NPI: 1871172437
Provider Name (Legal Business Name): MONICA HERBST WILDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23960 KATY FREEWAY, SUITE 450
KATY TX
77494-0895
US

IV. Provider business mailing address

6400 FANNIN STREET, SUITE 2070
HOUSTON TX
77030-1541
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-7980
  • Fax: 713-486-8085
Mailing address:
  • Phone: 713-486-8000
  • Fax: 713-486-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberW6254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: