Basic Information
| Provider Information | |||||||||
| NPI: | 1154367829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILLMAN | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | D. | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6410 FANNIN ST STE 350 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323257131 | ||||||||
| FaxNumber: | 7135122216 | ||||||||
| Practice Location | |||||||||
| Address1: | 6410 FANNIN ST STE 350 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323257131 | ||||||||
| FaxNumber: | 7135122216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Q2551 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | -027 | 01 | VA | TRICARE/CHAMPUS | OTHER | 1154367829 | 01 | VA | CIGNA | OTHER | 1154367829 | 01 | VA | SEDGWICK CMS | OTHER | 1154367829 | 01 | VA | COVENTRY NETWORK | OTHER | 1154367829 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 1154367829 | 01 | VA | UNITED HEALTHCARE | OTHER | 1154367829 | 01 | VA | MULTIPLAN | OTHER | 1154367829 | 01 | VA | CORVEL | OTHER | 1154367829 | 01 | VA | OPTIMA HEALTH | OTHER | 1154368729 | 05 | NC | MEDICAID | 1154367829 | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | 1154367829 | 05 | VA | MEDICAID | 530684 | 01 | VA | ANTHEM BC/BS | OTHER | 1154367829 | 01 | VA | USA MANAGED CARE | OTHER | 1154367829 | 01 | VA | AETNA | OTHER |